Tonita Jon M, Skarsgard David, Muhajarine Nazeem
Saskatchewan Cancer Agency, 400-2631 28th Avenue, Regina, Saskatchewan, Canada.
Cancer Causes Control. 2009 Mar;20(2):201-9. doi: 10.1007/s10552-008-9234-6. Epub 2008 Sep 30.
The prostate specific antigen (PSA) test became available in Saskatchewan in 1990 as a part of the provincial health plan. The purpose of this population-based study was to describe the changes in case mix and treatment patterns for prostate cancer following its introduction.
The Saskatchewan Cancer Registry was used to identify all new cases of prostate cancer for the period 1985-2001. We reviewed over 10,000 charts to collect information on tumor characteristics, diagnostic methods, and first choice of treatment. This information was linked to the demographic and mortality data from the registry.
The age-adjusted incidence of prostate cancer was influenced greatly by PSA testing volumes. Overall, the rate increased from 90.3 per 100,000 in 1985 to 151.3 per 100,000 in 2001. The increase was mostly organ-confined moderately differentiated cases. The incidence rate of metastatic disease dropped about 50% but only in the 70-79 and 80+ age groups. In 1985, 34% of cases were diagnosed by needle biopsy and 60.4% by TURP. In 2001, the values were 76.1% and 19.7%, respectively. More men now choose radical therapy as the first course of treatment, 81% during 1997-2001 compared to only 63.2% in the 1985-1989 period. Mortality rates remained stable in all age groups over these years.
There have been dramatic changes in the case mix of prostate cancers diagnosed since the introduction of PSA testing in the population and significant changes in clinical management of this disease. Thus far, no changes have occurred in mortality rates in the population.
1990年，前列腺特异性抗原（PSA）检测作为省级医疗计划的一部分在萨斯喀彻温省推行。这项基于人群的研究旨在描述引入该检测后前列腺癌病例组合及治疗模式的变化。
利用萨斯喀彻温癌症登记处识别出1985 - 2001年期间所有前列腺癌新发病例。我们查阅了10000多份病历，收集肿瘤特征、诊断方法及首选治疗方式等信息。这些信息与登记处的人口统计学和死亡率数据相关联。
前列腺癌的年龄调整发病率受PSA检测量影响很大。总体而言，发病率从1985年的每10万人90.3例增至2001年的每10万人151.3例。增加的主要是器官局限性中度分化病例。转移性疾病的发病率下降了约50%，但仅在70 - 79岁和80岁以上年龄组。1985年，34%的病例通过针吸活检诊断，60.4%通过经尿道前列腺切除术（TURP）诊断。2001年，这两个数值分别为76.1%和19.7%。现在更多男性选择根治性治疗作为首选治疗方案，1997 - 2001年期间为81%，而1985 - 1989年期间仅为63.2%。这些年所有年龄组的死亡率保持稳定。
自人群中引入PSA检测以来，所诊断的前列腺癌病例组合发生了显著变化，该疾病的临床管理也有重大改变。迄今为止，人群中的死亡率未发生变化。
