Gosselaar Claartje, Roobol Monique J, Roemeling Stijn, van der Kwast Theo H, Schröder Fritz H
Department of Urology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
Prostate. 2007 Feb 1;67(2):154-61. doi: 10.1002/pros.20501.
To compare tumor characteristics of screen-detected prostate cancers (PCs) either by digital rectal examination (DRE) or by prostate-specific antigen (PSA) as biopsy indication at low PSA.
Two populations with PSA between 2.0 and 3.9 ng/ml were studied. Group-1 was biopsied if DRE was suspicious (1st screening round, N = 1877). In group-2 all men were offered biopsy, regardless of DRE result (side-study in 2nd screening-round, N = 801). We compared cancer detection rates (CDRs) and tumor characteristics.
In group-1 abnormal DRE prompted biopsy in 253 (13.5%) men (236 (93.3%) actually biopsied). Forty-nine PCs were detected, CDR 49/1877 = 2.6%. In group-2 we found 120 cancers in 666 (83.1%) men actually biopsied, CDR = 120/801 = 15.0%. Of all cancers detected, organ confinement (clinical T2) was found in 77.5% (group-1) and 96.6% (group-2; of which 99 T1c). Of all PCs 46.9% in group-1 and 15.0% in group-2 had biopsy Gleason score (GS) > or = 7. In the latter, 15.2% of T1cs were classified GS > or = 7. Considering only PCs with organ confinement or GS > or = 7 for each group, CDRs amounted to 2.0% versus 14.5% and 1.2% versus 2.3% for group-1 and group-2, respectively.
PSA-based screening detected a considerable amount (15.2%) of potentially aggressive tumors as T1cs, but in addition large numbers of possibly insignificant cancers (T1c, GS = 6) were diagnosed. DRE seemed to detect more selectively high-grade cancers, but also missed many of these. Considering both populations and the need to detect aggressive but confined cancers, PSA as biopsy indication outperformed DRE at the price of more biopsies (13.5% vs. 100% if all would comply).
比较在低前列腺特异性抗原（PSA）水平下，以直肠指检（DRE）或PSA作为活检指征筛查出的前列腺癌（PC）的肿瘤特征。
研究了两组PSA水平在2.0至3.9 ng/ml之间的人群。如果DRE结果可疑，对第1组进行活检（第一轮筛查，N = 1877）。在第2组中，无论DRE结果如何，所有男性均接受活检（第二轮筛查中的辅助研究，N = 801）。我们比较了癌症检出率（CDR）和肿瘤特征。
在第1组中，253名（13.5%）男性因DRE异常而接受活检（实际活检236名（93.3%））。检测到49例PC，CDR为49/1877 = 2.6%。在第2组中，在实际活检的666名（83.1%）男性中发现120例癌症，CDR = 120/801 = 15.0%。在所有检测到的癌症中，局限于器官内（临床T2期）的比例在第1组为77.5%，在第2组为96.6%（其中99例为T1c期）。第1组中所有PC的46.9%和第2组中15.0%的活检Gleason评分（GS）≥7。在第2组中，15.2%的T1c期癌症被分类为GS≥7。仅考虑每组中局限于器官内或GS≥7的PC，第1组和第2组的CDR分别为2.0%对14.5%和1.2%对2.3%。
基于PSA的筛查检测出相当数量（15.2%）的潜在侵袭性肿瘤为T1c期，但此外还诊断出大量可能无意义的癌症（T1c期，GS = 6）。DRE似乎更有选择性地检测出高级别癌症，但也遗漏了许多此类癌症。考虑到这两组人群以及检测侵袭性但局限于器官内癌症的需求，以PSA作为活检指征优于DRE，但代价是活检次数更多（如果所有人都依从，分别为13.5%对100%）。
