Rochester M A, Donaldson P J, McLoughlin J
Department of Urology, West Suffolk and Ipswich Hospitals, Suffolk, UK.
Ann R Coll Surg Engl. 2008 Jul;90(5):398-402. doi: 10.1308/003588408X301019.
With increased use of serum prostate-specific antigen (PSA) testing, prostate cancers are diagnosed at an earlier stage in younger men, when radical curative treatments are appropriate. Modifications of the PSA test such as PSA velocity and age-adjusted values are available to aid in the selection of patients for biopsy. However, it is not clear whether these data are used in general practice.
A self-administered questionnaire was mailed to all primary care practices within one region in the UK. A series of visual analogue questions designed to identify referral thresholds for age-adjusted PSA levels and PSA velocity were used to identify patterns in referral behaviour.
Individual family practitioners see only small numbers of patients requesting PSA tests or with newly diagnosed prostate cancer each year. The median (range) thresholds considered for referral at ages 45, 55, 65, 75 and 85 years were 4.5 ng/ml (2.5-15.5 ng/ml), 5.5 ng/ml (3.0-15.5 ng/ml), 6.5 ng/ml (3.5-15.5 ng/ml), 6.5 ng/ml (3.5-25.5 ng/ml), and 7.5 ng/ml (3.5-25.5 ng/ml), respectively. Only 5% of practitioners correctly identified the age-specific PSA threshold for referral of a 45-year-old man.
It is important to remember that younger men (even those in their forties and fifties) may be at risk of prostate cancer even if asymptomatic. It is important in a climate of increasing demand for PSA testing that those who initiate the process understand the implications and limitations of testing, including appropriate triggers for referral to secondary care. The exact approach required for the successful dissemination of this information to primary care is not clear, but our data suggest that a better understanding is required.
随着血清前列腺特异性抗原（PSA）检测的使用增加，前列腺癌在年轻男性中得以在更早阶段被诊断出来，此时根治性治疗是合适的。PSA检测的一些修正指标，如PSA速率和年龄校正值，可用于帮助选择活检患者。然而，尚不清楚这些数据在常规医疗实践中是否被使用。
向英国一个地区内的所有初级医疗诊所邮寄了一份自填式问卷。一系列旨在确定年龄校正PSA水平和PSA速率转诊阈值的视觉模拟问题，被用于识别转诊行为模式。
个体家庭医生每年仅接待少量要求进行PSA检测或新诊断为前列腺癌的患者。45岁、55岁、65岁、75岁和85岁时考虑转诊的中位数（范围）阈值分别为4.5纳克/毫升（2.5 - 15.5纳克/毫升）、5.5纳克/毫升（3.0 - 15.5纳克/毫升）、6.5纳克/毫升（3.5 - 15.5纳克/毫升）、6.5纳克/毫升（3.5 - 25.5纳克/毫升）和7.5纳克/毫升（3.5 - 25.5纳克/毫升）。只有5%的医生正确识别了45岁男性转诊的年龄特异性PSA阈值。
重要的是要记住，即使无症状，年轻男性（甚至四五十岁的男性）也可能有患前列腺癌的风险。在对PSA检测需求不断增加的情况下，启动检测过程的人了解检测的影响和局限性，包括转诊至二级医疗的适当触发因素非常重要。将这些信息成功传播到初级医疗所需的确切方法尚不清楚，但我们的数据表明需要更好地理解。
