Howard Kirsten, Barratt Alex, Mann Graham J, Patel Manish I
Screening and Test Evaluation Program, School of Public Health, University of Sydney, Sydney, Australia.
Arch Intern Med. 2009 Sep 28;169(17):1603-10. doi: 10.1001/archinternmed.2009.282.
Information is needed to aid individual decision making about prostate-specific antigen (PSA) screening.
We aimed to provide such information for men aged 40, 50, 60, and 70 years at low, moderate, and high risk for prostate cancer. A Markov model compared patients with vs without annual PSA screening using a 20% relative risk (RR) reduction (RR = 0.8) in prostate cancer mortality as a best-case scenario. The model estimated numbers of biopsies, prostate cancers, and deaths from prostate cancer per 1000 men over 10 years and cumulated to age 85 years.
Benefits and harms vary substantially with age and familial risk. Using 60-year-old men with low risk as an example, of 1000 men screened annually, we estimate that 115 men will undergo biopsy triggered by an abnormal PSA screen result and that 53 men will be diagnosed as having prostate cancer over 10 years compared with 23 men diagnosed as having prostate cancer among 1000 unscreened men. Among screened men, 3.5 will die of prostate cancer over 10 years compared with 4.4 deaths in unscreened men. For 1000 men screened from 40 to 69 years of age, there will be 27.9 prostate cancer deaths and 639.5 deaths overall by age 85 years compared with 29.9 prostate cancer deaths and 640.4 deaths overall in unscreened men. Higher-risk men have more prostate cancer deaths averted but also more prostate cancers diagnosed and related harms.
Men should be informed of the likely benefits and harms of PSA screening. These estimates can be used to support individual decision making.
需要信息来辅助关于前列腺特异性抗原（PSA）筛查的个人决策。
我们旨在为年龄在40、50、60和70岁，患前列腺癌风险低、中、高的男性提供此类信息。一个马尔可夫模型比较了每年进行PSA筛查与不进行筛查的患者，将前列腺癌死亡率相对降低20%（相对风险[RR]=0.8）作为最佳情况。该模型估计了每1000名男性在10年期间的活检次数、前列腺癌病例数和前列腺癌死亡数，并累计至85岁。
益处和危害因年龄和家族风险而异。以60岁低风险男性为例，在每年接受筛查的1000名男性中，我们估计有115名男性会因PSA筛查结果异常而接受活检，10年期间有53名男性会被诊断为前列腺癌，而在1000名未筛查的男性中有23名会被诊断为前列腺癌。在接受筛查的男性中，10年期间有3.5人会死于前列腺癌，而未筛查男性中有4.4人死亡。对于40至69岁接受筛查的1000名男性，到85岁时将有27.9例前列腺癌死亡，总共639.5人死亡，而未筛查男性中有29.9例前列腺癌死亡，总共640.4人死亡。高风险男性避免的前列腺癌死亡更多，但也有更多被诊断出的前列腺癌病例及相关危害。
应告知男性PSA筛查可能带来的益处和危害。这些估计值可用于支持个人决策。
