Neal D E, Donovan J L
School of Surgical Sciences, Medical School, University of Newcastle upon Tyne, UK.
Lancet Oncol. 2000 Sep;1(1):17-24. doi: 10.1016/S1470-2045(00)00005-X.
The aim of screening is to identify cancers that are potentially curable; before a programme can be introduced, it must satisfy the requirement that it does more good than harm, particularly in terms of survival and quality of life. Prostate cancer is a common disease in older men and presents a significant burden to health services. Prostatic tumours range from small slow-growing lesions to aggressive tumours that metastasise rapidly, but because the natural history of prostate cancer is poorly understood, there is controversy about which screen-detected lesions will become clinically significant. Current methods of screening involve measurement of serum prostate specific antigen, followed by transrectal ultrasound scanning and biopsy, but these lack adequate specificity and sensitivity. There are three major treatment options for localised disease: radical prostatectomy, radical radiotherapy, and monitoring with treatment if required. There is no randomised controlled trial evidence to suggest a survival advantage of any of these treatments, and each has risks. There is intense speculation about future developments in diagnostic testing, molecular markers of progression, and early chemoprevention, but the central question that remains is whether radical treatments can improve survival and quality of life.
筛查的目的是识别有可能治愈的癌症；在引入一项筛查计划之前，它必须满足利大于弊的要求，尤其是在生存和生活质量方面。前列腺癌是老年男性的常见疾病，给医疗服务带来了沉重负担。前列腺肿瘤从小的生长缓慢的病变到迅速转移的侵袭性肿瘤不等，但由于对前列腺癌的自然病程了解不足，对于哪些经筛查发现的病变会发展为具有临床意义的病变存在争议。目前的筛查方法包括测量血清前列腺特异性抗原，随后进行经直肠超声扫描和活检，但这些方法缺乏足够的特异性和敏感性。对于局限性疾病有三种主要治疗选择：根治性前列腺切除术、根治性放疗以及必要时进行治疗监测。没有随机对照试验证据表明这些治疗方法中的任何一种具有生存优势，而且每种方法都有风险。对于诊断检测、进展的分子标志物以及早期化学预防的未来发展有很多猜测，但仍然存在的核心问题是根治性治疗能否提高生存率和生活质量。
