前列腺癌的前列腺特异性抗原检测：对英国全科医生观点及报告实践的在线调查
PSA testing for prostate cancer: an online survey of the views and reported practice of General Practitioners in the UK.
作者信息
Brett Jo, Watson Eila, Hewitson Paul, Bukach Colleen, Edwards Adrian, Elwyn Glyn, Austoker Joan
机构信息
Cancer Research UK Primary Care Education Research Group, Department of Primary Health Care, Old Road Campus, University of Oxford, Headington, Oxford, OX3 7LF, UK.
出版信息
BMC Fam Pract. 2005 Jun 9;6(1):24. doi: 10.1186/1471-2296-6-24.
BACKGROUND
The role of Prostate Specific Antigen (PSA) testing in the early detection of prostate cancer is controversial. Current UK policy stipulates that any man who wishes to have a PSA test should have access to the test, provided he has been given full information about the benefits and limitations of testing. This study aimed to determine UK GPs' current reported practice regarding PSA testing, and their views towards informed decision-making and PSA testing.
METHOD
Online questionnaire survey, with a sample of 421 GPs randomly selected from a database of GPs across the UK.
RESULTS
95% (400/421) of GPs responded. 76% of GPs reported having performed a PSA test for an asymptomatic man at least once in the previous three months, with 13% reported having tested more than five men in this period. A majority of GPs reported they would do a PSA test for men presenting with a family history and requesting a test, for asymptomatic men requesting a test and also for men presenting with lower urinary tract symptoms. Reported testing rates were highest for men with a family history. Amongst men with lower urinary tract symptoms and men with no symptoms, reported testing rates were significantly higher for older than younger men. The majority of GPs expressed support for the current policy (67%), and favoured both the general practitioner and the man being involved in the decision making process (83%). 90% of GPs indicated that they would discuss the benefits and limitation of testing with the man, with most (61%) preferring to ask the man to make a further appointment if he decides to be tested.
CONCLUSION
This study indicates that PSA testing in asymptomatic men is a regular occurrence in the UK, and that there is general support from GPs for the current policy of making PSA tests available to 'informed' men who are concerned about prostate cancer. While most GPs indicated they would discuss the benefits and limitations prior to PSA testing, and most GPs favoured a shared approach to decision making, it is not known to what extent men are actually being informed. Research is needed to evaluate the most effective approach to assisting men in making an informed decision about whether or not to have a PSA test.
背景
前列腺特异性抗原（PSA）检测在前列腺癌早期检测中的作用存在争议。英国现行政策规定，任何希望进行PSA检测的男性都应能够进行该检测，前提是他已充分了解检测的益处和局限性。本研究旨在确定英国全科医生目前报告的关于PSA检测的做法，以及他们对知情决策和PSA检测的看法。
方法
在线问卷调查，从英国全科医生数据库中随机抽取421名全科医生作为样本。
结果
95%（400/421）的全科医生做出了回应。76%的全科医生报告称，在过去三个月中至少为一名无症状男性进行过一次PSA检测，13%的全科医生报告在此期间为五名以上男性进行过检测。大多数全科医生报告称，他们会为有家族病史并要求检测的男性、无症状且要求检测的男性以及有下尿路症状的男性进行PSA检测。有家族病史的男性报告的检测率最高。在有下尿路症状的男性和无症状的男性中，年龄较大者的报告检测率显著高于年龄较小者。大多数全科医生对现行政策表示支持（67%），并赞成全科医生和男性都参与决策过程（83%）。90%的全科医生表示，他们会与男性讨论检测的益处和局限性，大多数（61%）倾向于如果男性决定进行检测，要求其再次预约。
结论
本研究表明，在英国，对无症状男性进行PSA检测是常有的事，全科医生普遍支持现行政策，即向关注前列腺癌的“知情”男性提供PSA检测。虽然大多数全科医生表示他们会在PSA检测前讨论益处和局限性，且大多数全科医生赞成共同决策的方法，但不清楚男性实际得到了多少信息。需要开展研究以评估协助男性就是否进行PSA检测做出知情决策的最有效方法。
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