Concato John, Wells Carolyn K, Horwitz Ralph I, Penson David, Fincke Graeme, Berlowitz Dan R, Froehlich Gregory, Blake Dawna, Vickers Martyn A, Gehr Gerald A, Raheb Nabil H, Sullivan Gail, Peduzzi Peter
Clinical Epidemiology Research Center and Cooperative Studies Program Coordinating Center, Department of Veterans Affairs Connecticut Healthcare System, West Haven Veterans Affairs Medical Center 06516, USA.
Arch Intern Med. 2006 Jan 9;166(1):38-43. doi: 10.1001/archinte.166.1.38.
Screening for prostate cancer is done commonly in clinical practice, using prostate-specific antigen (PSA) tests or digital rectal examination (DRE). Evidence is lacking, however, to confirm a survival benefit among screened patients. We evaluated the effectiveness of PSA, with or without DRE, in reducing mortality.
We conducted a multicenter nested case-control study at 10 Veterans Affairs medical centers in New England. Among 71 661 patients receiving ambulatory care between 1989 and 1990, 501 case patients were identified as men who were diagnosed as having adenocarcinoma of the prostate from 1991 through 1995 and who died sometime between 1991 and 1999. Control patients were men who were alive at the time the corresponding case patient had died, matched (1:1 ratio) for age and Veterans Affairs facility. The exposure variable (determined blind to case-control status) was whether PSA testing or DRE was performed for screening prior to the diagnosis of prostate cancer among case patients, with the same time interval for control patients. The association of screening and overall or cause-specific (prostate cancer) mortality was adjusted for race and comorbidity.
A benefit of screening was not found in our primary analysis assessing PSA screening and all-cause mortality (adjusted odds ratio, 1.08; 95% confidence interval, 0.71-1.64; P=.72), nor in a secondary analysis of PSA and/or DRE screening and cause-specific mortality (adjusted odds ratio, 1.13; 95% confidence interval, 0.63-2.06; P=.68).
These results do not suggest that screening with PSA or DRE is effective in reducing mortality. Recommendations for obtaining "verbal informed consent" from men regarding such screening should continue.
在临床实践中，常用前列腺特异性抗原（PSA）检测或直肠指检（DRE）来筛查前列腺癌。然而，尚无证据证实筛查患者能从中获得生存益处。我们评估了PSA单独或联合DRE在降低死亡率方面的有效性。
我们在新英格兰的10家退伍军人事务医疗中心进行了一项多中心巢式病例对照研究。在1989年至1990年间接受门诊治疗的71661名患者中，501例病例患者被确定为在1991年至1995年间被诊断为前列腺腺癌且在1991年至1999年间死亡的男性。对照患者为在相应病例患者死亡时仍存活的男性，按年龄和退伍军人事务机构进行匹配（1:1比例）。暴露变量（在不知道病例对照状态的情况下确定）是病例患者在前列腺癌诊断之前是否进行了PSA检测或DRE筛查，对照患者的时间间隔相同。对筛查与总死亡率或特定病因（前列腺癌）死亡率之间的关联进行了种族和合并症的调整。
在我们评估PSA筛查与全因死亡率的主要分析中未发现筛查的益处（调整优势比，1.08；95%置信区间，0.71 - 1.64；P = 0.72），在PSA和/或DRE筛查与特定病因死亡率的次要分析中也未发现（调整优势比，1.13；95%置信区间，0.63 - 2.06；P = 0.68）。
这些结果并不表明PSA或DRE筛查能有效降低死亡率。关于此类筛查，应继续向男性获取“口头知情同意”的建议。
