Concato John
Veterans Affairs (VA) Clinical Epidemiology Research Center (CERC), VA Connecticut Healthcare System, West Haven, CT, USA.
Cancer J. 2009 Jan-Feb;15(1):7-12. doi: 10.1097/PPO.0b013e31819765da.
Screening for prostate cancer with prostate-specific antigen remains controversial approximately 20 years after its introduction into routine clinical care. Although numerous research studies have generated evidence to support or refute a benefit of screening, very few reports focus on the most relevant outcome of reducing mortality, and even fewer use rigorous methods of patient-oriented research. In addition, the tendency for personal beliefs (among investigators) to influence the interpretation of data introduces further complexity. Two major randomized trials evaluating the association of screening for prostate cancer and mortality are ongoing, and the results from these trials are anticipated as if an "emperor" was about to make a pronouncement. In reality, however, the expectation of a definitive answer from these trials may overlook methodological problems and underestimate the uncertainty inherent in scientific investigations. As of 2008, the need to counsel patients regarding the possible benefits and harms that can result from screening for (and treating) prostate cancer remains justified.
前列腺特异性抗原用于前列腺癌筛查在被引入常规临床护理约20年后仍存在争议。尽管众多研究已产生支持或反驳筛查益处的证据，但极少有报告聚焦于降低死亡率这一最相关的结果，采用严格的以患者为导向的研究方法的报告更少。此外，（研究者中）个人信念影响数据解读的倾向进一步增加了复杂性。两项评估前列腺癌筛查与死亡率关联的大型随机试验正在进行，人们期待这些试验的结果，就好像一位“皇帝”即将做出宣判。然而，实际上，期望从这些试验中得到明确答案可能会忽略方法学问题，并低估科学研究中固有的不确定性。截至2008年，就前列腺癌筛查（及治疗）可能带来的益处和危害向患者提供咨询仍然是合理的。
