van der Cruijsen-Koeter Ingrid W, Roobol Monique J, Wildhagen Mark F, van der Kwast T H, Kirkels W J, Schröder Fritz H
Department of Urology, Josephine Nefkens Institute, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands.
Urology. 2006 Sep;68(3):615-20. doi: 10.1016/j.urology.2006.03.015.
To evaluate the tumor characteristics and prognostic factors in screen-detected prostate cancers in two successive screening rounds with a 4-year screening interval in the European Randomized Study of Screening for Prostate Cancer, section Rotterdam.
From 1993 to 2000, 42,376 men (21,210 in the screening arm and 21,166 in the control arm) were randomized and screened. Prostate-specific antigen testing, digital rectal examination, transrectal ultrasonography, and sextant biopsies were offered to the participants in the screening arm. A total of 1218 men with a biopsy indication at the first screening received an additional screening after 1 year (early recall). By 2004, all men had received their second screening. Interval carcinomas were defined as cancers detected during the screening interval and were identified by linkage with the Cancer Registry.
In the first round, 1014 prostate cancers were detected--24 in the men noncompliant to screening, 63 at the early recall screening, and 433 in the second round of screening. Also, 62 interval carcinomas were diagnosed. In the second screening round, the mean prostate-specific antigen value was lower (5.6 versus 11.1 ng/mL), advanced clinical stage T3-T4 was 7.1-fold less common, and 76.4% versus 61.5% of the biopsy Gleason scores were less than 7. In the first screening round, 13 regional and 9 distant metastases were detected; in the second round, 2 cases with distant metastasis were found.
Overall, a shift toward more favorable tumor characteristics was seen for the second round of screening. These results support the screening methods used and the interscreening interval of 4 years.
在欧洲前列腺癌筛查随机研究鹿特丹分部中，评估连续两轮、筛查间隔为4年的筛查发现的前列腺癌的肿瘤特征和预后因素。
1993年至2000年，42376名男性（筛查组21210名，对照组21166名）被随机分组并接受筛查。筛查组的参与者接受前列腺特异性抗原检测、直肠指检、经直肠超声检查和六分区活检。共有1218名在首次筛查时有活检指征的男性在1年后接受了额外筛查（早期召回）。到2004年，所有男性都接受了第二次筛查。间期癌定义为在筛查间隔期间发现的癌症，并通过与癌症登记处的关联来识别。
在第一轮筛查中，检测到1014例前列腺癌——24例在未依从筛查的男性中，63例在早期召回筛查中，433例在第二轮筛查中。此外，诊断出62例间期癌。在第二轮筛查中，前列腺特异性抗原的平均数值较低（5.6对11.1 ng/mL），临床晚期T3 - T4的情况少见7.1倍，活检Gleason评分低于7分的比例为76.4%对61.5%。在第一轮筛查中，检测到13例区域转移和9例远处转移；在第二轮筛查中，发现2例远处转移病例。
总体而言，第二轮筛查显示肿瘤特征向更有利的方向转变。这些结果支持所采用的筛查方法和4年的筛查间隔。
