Marcella Stephen W, Rhoads George G, Carson Jeffrey L, Merlino Frances, Wilcox Homer
Department of Epidemiology, UMDNJ-School of Public Health, Piscataway, NJ 08854, USA.
J Gen Intern Med. 2008 Mar;23(3):248-53. doi: 10.1007/s11606-007-0479-7. Epub 2008 Jan 3.
There is no available evidence from randomized trials that early detection of prostate cancer improves health outcomes, but the prostate-specific antigen (PSA) test is commonly used to screen men for prostate cancer.
The objective of the study is to see if screening with PSA decreases mortality from prostate cancer.
DESIGN, SETTING, AND PARTICIPANTS: This is a case-control study using one-to-one matching on race, age, and time of availability of exposure to PSA screening. Decedents, 380, from New Jersey Vital Statistics 1997 to 2000 inclusive, 55-79 years of age at diagnosis were matched to living controls without metastatic prostate cancer. Medical records were obtained from all providers, and we abstracted information about PSA tests from 1989 to the time of diagnosis in each index case.
Measurements consist of a comparison of screening (yes, no) between cases and controls. Measure of association was the odds ratio.
Eligible cases were diagnosed each year from 1989 to 1999 with the median year being 1993. PSA screening was evident in 23.2-29.2% of cases and 21.8-26.1% of controls depending on the screening criteria. The unadjusted, matched odds ratio for dying of prostate cancer if ever screened was 1.09 (95% CI 0.76 to 1.60) for the most restrictive criteria and 1.19 (95% CI, 0.85 to 1.66) for the least restrictive. Adjustment for comorbidity and education level made no significant differences in these values. There were no significant interactions by age or race.
PSA screening using an ever/never tabulation for tests from 1989 until 2000 did not protect New Jersey men from prostate cancer mortality.
随机试验中尚无证据表明早期检测前列腺癌能改善健康结局，但前列腺特异性抗原（PSA）检测常用于男性前列腺癌筛查。
本研究的目的是探讨PSA筛查是否能降低前列腺癌死亡率。
设计、地点和参与者：这是一项病例对照研究，根据种族、年龄和接触PSA筛查的时间进行一对一匹配。选取1997年至2000年新泽西州生命统计数据中的380名死者作为病例，诊断时年龄为55至79岁，与无转移性前列腺癌的在世对照进行匹配。从所有医疗服务提供者处获取病历，并提取每个索引病例从1989年到诊断时的PSA检测信息。
测量指标包括病例组和对照组之间筛查情况（是、否）的比较。关联度量为比值比。
1989年至1999年每年均有符合条件的病例被诊断，中位年份为1993年。根据筛查标准，23.2%至29.2%的病例和21.8%至26.1%的对照进行了PSA筛查。对于最严格的标准，曾接受筛查的前列腺癌死亡未调整匹配比值比为1.09（95%CI 0.76至1.60），对于最宽松的标准为1.19（95%CI 0.85至1.66）。对合并症和教育水平进行调整后，这些值无显著差异。年龄或种族之间无显著交互作用。
对1989年至2000年的检测采用“曾/未”列表法进行PSA筛查，未能保护新泽西州男性免于前列腺癌死亡。
