Lin Kenneth, Lipsitz Robert, Miller Therese, Janakiraman Supriya
Center for Primary Care, Prevention, and Clinical Partnerships, Agency for Healthcare Research and Quality, Rockville, Maryland 20850, USA.
Ann Intern Med. 2008 Aug 5;149(3):192-9. doi: 10.7326/0003-4819-149-3-200808050-00009.
Prostate cancer is the most common nonskin cancer in men in the United States, and prostate cancer screening has increased in recent years. In 2002, the U.S. Preventive Services Task Force concluded that evidence was insufficient to recommend for or against screening for prostate cancer with prostate-specific antigen (PSA) testing.
To examine new evidence on benefits and harms of screening asymptomatic men for prostate cancer with PSA.
English-language articles identified in PubMed and the Cochrane Library (search dates, January 2002 to July 2007), reference lists of retrieved articles, and expert suggestions.
Randomized, controlled trials and meta-analyses of PSA screening and cross-sectional and cohort studies of screening harms and of the natural history of screening-detected cancer were selected to answer the following questions: Does screening for prostate cancer with PSA, as a single-threshold test or as a function of multiple tests over time, decrease morbidity or mortality? What are the magnitude and nature of harms associated with prostate cancer screening, other than overtreatment? What is the natural history of PSA-detected, nonpalpable, localized prostate cancer?
Studies were reviewed, abstracted, and rated for quality by using predefined U.S. Preventive Services Task Force criteria.
No good-quality randomized, controlled trials of screening for prostate cancer have been completed. In 1 cross-sectional and 2 prospective cohort studies of fair to good quality, false-positive PSA screening results caused psychological adverse effects for up to 1 year after the test. The natural history of PSA-detected prostate cancer is poorly understood.
Few eligible studies were identified. Long-term adverse effects of false-positive PSA screening test results are unknown.
Prostate-specific antigen screening is associated with psychological harms, and its potential benefits remain uncertain.
前列腺癌是美国男性中最常见的非皮肤癌，近年来前列腺癌筛查有所增加。2002年，美国预防服务工作组得出结论，证据不足以推荐支持或反对使用前列腺特异性抗原（PSA）检测进行前列腺癌筛查。
研究对无症状男性进行PSA前列腺癌筛查的益处和危害的新证据。
在PubMed和Cochrane图书馆中检索到的英文文章（检索日期为2002年1月至2007年7月）、检索文章的参考文献列表以及专家建议。
选择PSA筛查的随机对照试验和荟萃分析以及筛查危害和筛查发现癌症自然史的横断面和队列研究，以回答以下问题：使用PSA作为单一阈值检测或随时间进行多次检测来筛查前列腺癌是否能降低发病率或死亡率？除过度治疗外，与前列腺癌筛查相关的危害的程度和性质是什么？PSA检测到的、不可触及的局限性前列腺癌的自然史是怎样的？
使用预先定义的美国预防服务工作组标准对研究进行审查、摘要提取和质量评级。
尚未完成高质量的前列腺癌筛查随机对照试验。在1项质量一般到良好的横断面研究和2项前瞻性队列研究中，PSA筛查假阳性结果在检测后长达1年的时间里对心理产生了不良影响。人们对PSA检测到的前列腺癌的自然史了解甚少。
符合条件的研究很少。PSA筛查假阳性检测结果的长期不良影响尚不清楚。
前列腺特异性抗原筛查与心理危害相关，其潜在益处仍不确定。
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