Hoffman Richard M, Stone S Noell, Espey David, Potosky Arnold L
Medicine Service, New Mexico VA Health Care System, Albuquerque, New Mexico, USA.
BMC Cancer. 2005 Mar 8;5:27. doi: 10.1186/1471-2407-5-27.
The advent of prostate specific antigen (PSA) testing in the United States of America (USA) has led to a dramatic increase in the incidence of prostate cancer in the United States as well as the number of men undergoing aggressive treatment with radical prostatectomy and radiation therapy. We compared patient characteristics and treatment selection between American men with screening-detected versus clinically diagnosed prostate cancers.
We evaluated 3,173 men with prostate cancer in the USA. Surveys and medical records provided information on demographics, socioeconomic status, comorbidities, symptoms, tumor characteristics, and treatment. We classified men presenting with symptoms of advanced cancer - bone pain, weight loss, or hematuria - as "clinically diagnosed"; asymptomatic men and those with only lower urinary tract symptoms were considered "screening-detected." We used multivariate analyses to determine whether screening predicted receiving aggressive treatment for a clinically localized cancer.
We classified 11% of cancers as being clinically diagnosed. Men with screening-detected cancers were more often non-Hispanic white (77% vs. 65%, P < 0.01), younger (36% < 65 years vs. 25%, P <or= 0.01), better educated (80% >or= high school vs. 67%, P < 0.01), healthier (18% excellent health vs. 10%, P < 0.01), and diagnosed with localized disease (90% vs. 75%, P < 0.01). Men with screening-detected localized cancers more often underwent aggressive treatment, 76% vs. 70%, P = 0.05.
Most cancers were detected by screening in this American cohort. Appropriately, younger, healthier men were more likely to be diagnosed by screening. Minority status and lower socio-economic status appeared to be screening barriers. Screening detected earlier-stage cancers and was associated with receiving aggressive treatment.
前列腺特异性抗原（PSA）检测在美国的出现，导致美国前列腺癌的发病率急剧上升，同时接受根治性前列腺切除术和放射治疗等积极治疗的男性人数也大幅增加。我们比较了美国筛查发现的前列腺癌男性患者与临床诊断的前列腺癌男性患者的特征及治疗选择。
我们评估了美国3173名前列腺癌男性患者。通过调查和医疗记录获取了有关人口统计学、社会经济地位、合并症、症状、肿瘤特征及治疗的信息。我们将出现晚期癌症症状（骨痛、体重减轻或血尿）的男性归类为“临床诊断”；无症状男性及仅有下尿路症状的男性被视为“筛查发现”。我们采用多变量分析来确定筛查是否能预测对临床局限性癌症进行积极治疗。
我们将11%的癌症归类为临床诊断。筛查发现癌症的男性更常为非西班牙裔白人（77%对65%，P<0.01）、更年轻（36%<65岁对25%，P≤0.01）、受教育程度更高（80%≥高中对67%，P<0.01）、更健康（18%健康状况极佳对10%，P<0.01），且被诊断为局限性疾病（90%对75%，P<0.01）。筛查发现局限性癌症的男性更常接受积极治疗，分别为76%和70%，P = 0.05。
在这个美国队列中，大多数癌症是通过筛查发现的。相应地，更年轻、更健康的男性更有可能通过筛查被诊断出来。少数族裔身份和较低的社会经济地位似乎是筛查的障碍。筛查能发现早期癌症，并与接受积极治疗相关。
