Thompson Ian M, Tangen Catherine M, Goodman Phyllis J, Lucia M Scott, Parnes Howard L, Lippman Scott M, Coltman Charles A
Department of Urology, University of Texas Health Science Center at San Antonio, San Antonio, Texas 78229, USA.
J Urol. 2007 May;177(5):1749-52. doi: 10.1016/j.juro.2007.01.071.
Men undergoing screening for prostate cancer are recommended to undergo digital rectal examination and prostate specific antigen measurement. We previously presented data from the Prostate Cancer Prevention Trial indicating that finasteride improves the performance characteristics of prostate specific antigen for cancer detection. In the current study we report the impact of finasteride on digital rectal examination sensitivity and specificity.
We examined the sensitivity and specificity of digital rectal examination in Prostate Cancer Prevention Trial subjects receiving finasteride or placebo who underwent prostate biopsy, had prostate specific antigen measurement and digital rectal examination within 1 year before biopsy and were on treatment at biopsy.
Of 9,423 men in the finasteride group 4,579 and 5,112 of 9,459 in the placebo group met study evaluation requirements. Of 4,579 men in the finasteride group 695, including 264 with Gleason 7 or greater and 81 with Gleason 8 or greater, and 1,111 of 5,112 in the placebo group, including 240 with Gleason 7 or greater and 55 with Gleason 8 or greater, were diagnosed with prostate cancer. In men in the placebo and finasteride groups digital rectal examination sensitivity was greater for detecting higher grade tumors. The sensitivity of digital rectal examination was significantly greater for cancer detection in men receiving finasteride than placebo (21.3% vs 16.7%, p=0.015). Digital rectal examination sensitivity was also greater for detecting high grade (Gleason 7 or greater and 8 or greater) cancers in men receiving finasteride but this did not attain statistical significance. Digital rectal examination specificity was similar in men receiving finasteride or placebo.
Finasteride significantly improves prostate cancer detection with digital rectal examination.
建议接受前列腺癌筛查的男性进行直肠指检和前列腺特异性抗原检测。我们之前公布了前列腺癌预防试验的数据，表明非那雄胺可改善前列腺特异性抗原用于癌症检测的性能特征。在本研究中，我们报告了非那雄胺对直肠指检敏感性和特异性的影响。
我们在前列腺癌预防试验中，对接受非那雄胺或安慰剂治疗、进行前列腺活检、在活检前1年内进行前列腺特异性抗原检测和直肠指检且在活检时仍在接受治疗的受试者，检查直肠指检的敏感性和特异性。
非那雄胺组的9423名男性中，4579名符合研究评估要求；安慰剂组的9459名男性中，5112名符合要求。非那雄胺组的4579名男性中，695名被诊断为前列腺癌，其中包括264名Gleason评分7分及以上者和81名Gleason评分8分及以上者；安慰剂组的5112名男性中，1111名被诊断为前列腺癌，其中包括240名Gleason评分7分及以上者和55名Gleason评分8分及以上者。在安慰剂组和非那雄胺组男性中，直肠指检对检测高级别肿瘤的敏感性更高。接受非那雄胺治疗的男性中，直肠指检对癌症检测的敏感性显著高于安慰剂组（21.3%对16.7%，p=0.015）。接受非那雄胺治疗的男性中，直肠指检对检测高级别（Gleason评分7分及以上和8分及以上）癌症的敏感性也更高，但未达到统计学意义。接受非那雄胺或安慰剂治疗的男性中，直肠指检特异性相似。
非那雄胺可显著提高直肠指检对前列腺癌的检测率。
