Agalliu Ilir, Weiss Noel S, Lin Daniel W, Stanford Janet L
Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue N, M4-B874, Seattle, WA 98109, USA.
Cancer Causes Control. 2007 Nov;18(9):931-7. doi: 10.1007/s10552-007-9031-7. Epub 2007 Jul 20.
Although prostate cancer screening by measurement of serum prostate-specific antigen (PSA) and digital rectal examination (DRE) is common in clinical practice, the impact of such screening on prostate cancer-specific mortality remains uncertain.
Data from a population-based case-control study in King County, Washington, among men aged 50-64 years (706 cases, 645 controls) were used to examine the relationships between PSA and DRE screening and fatal prostate cancer and other-cause mortality. Incident cases were diagnosed in 1993-1996, identified via the Seattle-Puget Sound SEER cancer registry and followed for vital status through 1 June 2007. Controls were ascertained by random digit dialing and frequency age-matched to cases. The screening variable used in this analysis was self-reported receipt of one or more PSA and/or DRE tests performed as part of a routine checkup in the five-year period before diagnosis or reference date.
A smaller proportion of men with fatal prostate cancer had one or more PSA and/or DRE screening tests compared to controls, resulting in an adjusted odds ratios (OR) of 0.38 (95% CI 0.19-0.77). There was no association, however, between PSA and/or DRE screening and other-cause mortality (OR = 1.02; 95% CI 0.51-2.02).
Results of this study suggest a reduction in prostate cancer-specific mortality associated with PSA and/or DRE screening in middle-aged men. Findings should be interpreted cautiously, however, as results are based on observational data. Further, the study was not able to separate the relative efficacy of PSA versus DRE screening.
尽管在临床实践中，通过检测血清前列腺特异性抗原（PSA）和直肠指检（DRE）进行前列腺癌筛查很常见，但这种筛查对前列腺癌特异性死亡率的影响仍不确定。
利用华盛顿州金县一项基于人群的病例对照研究的数据，该研究针对50 - 64岁男性（706例病例，645例对照），以检验PSA和DRE筛查与致命性前列腺癌及其他原因死亡率之间的关系。1993 - 1996年确诊的新发病例通过西雅图 - 普吉特海湾监测、流行病学和最终结果（SEER）癌症登记处识别，并随访至2007年6月1日的生命状态。对照通过随机数字拨号确定，并按年龄频率与病例匹配。本分析中使用的筛查变量是自我报告在诊断或参考日期前五年内作为常规体检一部分接受过一次或多次PSA和/或DRE检测。
与对照组相比，死于前列腺癌的男性中接受过一次或多次PSA和/或DRE筛查检测的比例较小，调整后的比值比（OR）为0.38（95%置信区间0.19 - 0.77）。然而，PSA和/或DRE筛查与其他原因死亡率之间没有关联（OR = 1.02；95%置信区间0.51 - 2.02）。
本研究结果表明，中年男性中PSA和/或DRE筛查与前列腺癌特异性死亡率降低有关。然而，由于结果基于观察性数据，应谨慎解读这些发现。此外，该研究无法区分PSA筛查与DRE筛查的相对疗效。
