Chadwick D J, Kemple T, Astley J P, MacIver A G, Gillatt D A, Abrams P, Gingell J C
Horfield Health Centre, Bristol, UK.
Lancet. 1991 Sep 7;338(8767):613-6. doi: 10.1016/0140-6736(91)90615-v.
The success of a screening programme for cancer depends on the sensitivity of the tests used and on the proportion of the target population that comes forward for screening. To assess the value of digital rectal screening and prostate-specific antigen (PSA) measurement as screening measures, the 814 men in a city general practice aged between 55 and 70 were recruited in one of five different ways. Men with a palpably suspicious prostate or a serum PSA greater than 4 ng/ml were referred for transrectal ultrasonography and, if indicated, biopsy. 472 men (58%) were screened; of these 68 underwent transrectal ultrasonography and 29 biopsy. In 7 the biopsy specimen showed carcinoma. Serum PSA was better than digital examination as a screening test--all men with prostate cancer had raised concentrations of serum PSA, whereas only 1 had a palpably abnormal prostate. All 7 had localised disease, and 5 underwent radical prostatectomy. The best methods of patient recruitment were to send an appointment for screening and to "tag" the patient's notes.
癌症筛查项目的成功取决于所使用检测方法的敏感性以及主动前来接受筛查的目标人群比例。为评估直肠指检和前列腺特异性抗原（PSA）检测作为筛查手段的价值，以五种不同方式之一招募了该市一家普通诊所中年龄在55至70岁之间的814名男性。前列腺可触及可疑或血清PSA大于4 ng/ml的男性被转诊进行经直肠超声检查，如有必要则进行活检。472名男性（58%）接受了筛查；其中68人进行了经直肠超声检查，29人进行了活检。7例活检标本显示为癌。血清PSA作为筛查检测方法优于直肠指检——所有前列腺癌患者的血清PSA浓度均升高，而只有1例前列腺可触及异常。所有7例均为局限性疾病，5例接受了根治性前列腺切除术。最佳的患者招募方法是发送筛查预约通知并在患者病历上“标记”。
