Weinmann Sheila, Richert-Boe Kathryn E, Van Den Eeden Stephen K, Enger Shelley M, Rybicki Benjamin A, Shapiro Jean A, Weiss Noel S
Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Avenue, Portland, OR 97227, USA.
Epidemiology. 2005 May;16(3):367-76. doi: 10.1097/01.ede.0000158395.05136.02.
The potential role of prostate cancer screening in reducing mortality is uncertain. To examine whether screening with the prostate-specific antigen (PSA) test or digital rectal examination is associated with reduced prostate cancer mortality, we conducted a population-based case-control study in 4 health maintenance organizations.
Cases were 769 health plan members who died because of prostate adenocarcinoma during the years 1997-2001. We randomly selected 929 controls from the health plan membership and matched them to cases on health plan, age, race, and membership history. Medical records were used to document all screening tests in the 10 years before and including the date on which prostate cancer was first suspected.
Among white participants, 62% of cases and 69% of controls had a least 1 screening PSA test or digital rectal examination (odds ratio = 0.73; 95% confidence interval = 0.55-0.97). The corresponding proportions for blacks were 59% and 61% (1.0; 0.59-1.4). Most screening tests were digital rectal examinations; therefore, in the subgroup with no history of PSA screening, the association between digital rectal screening and prostate cancer mortality was similar to the overall association (0.65 [0.48-0.88] among whites; 0.86 [0.53-1.4] among blacks). Very few men received screening PSA without screening digital rectal examination (6% of cases and 7% of controls among whites).
Digital rectal screening was associated with a reduced risk of death due to prostate cancer in our population. Because of several data limitations, this study could not accurately estimate the effect of PSA screening separate from digital rectal examination.
前列腺癌筛查在降低死亡率方面的潜在作用尚不确定。为了研究前列腺特异性抗原（PSA）检测或直肠指检筛查是否与降低前列腺癌死亡率相关，我们在4个健康维护组织中开展了一项基于人群的病例对照研究。
病例为1997年至2001年期间因前列腺腺癌死亡的769名健康计划成员。我们从健康计划成员中随机选取929名对照，并根据健康计划、年龄、种族和成员资格历史将他们与病例进行匹配。使用医疗记录记录在首次怀疑前列腺癌之前及包括该日期在内的10年中的所有筛查检测。
在白人参与者中，62%的病例和69%的对照至少进行过1次PSA筛查检测或直肠指检（比值比 = 0.73；95%置信区间 = 0.55 - 0.97）。黑人的相应比例分别为59%和61%（1.0；0.59 - 1.4）。大多数筛查检测是直肠指检；因此，在无PSA筛查史的亚组中，直肠指检筛查与前列腺癌死亡率之间的关联与总体关联相似（白人中为0.65[0.48 - 0.88]；黑人中为0.86[0.53 - 1.4]）。很少有男性在未进行直肠指检的情况下接受PSA筛查（白人中6%的病例和7%的对照）。
在我们的研究人群中，直肠指检筛查与降低前列腺癌死亡风险相关。由于存在一些数据局限性，本研究无法准确估计独立于直肠指检的PSA筛查的效果。
