Department of Urology, First Affiliated Hospital of Nanjing Medical University, 210029 Nanjing, China.
Med Oncol. 2011 Mar;28(1):357-64. doi: 10.1007/s12032-009-9409-3. Epub 2010 Jan 14.
Previous studies have suggested that implementation of PSA screening in China is of crucial importance. This study compared clinical and pathological characteristics of screen-detected and clinically diagnosed prostate cancers and evaluated the effectiveness of PSA screening for early detection of prostate cancer in Nanjing. Between July 2004 and December 2005, 8,562 men aged ≥ 50 years were included for PSA screening. Participants with serum PSA ≥ 4.0 ng/ml were recommended for transrectal ultrasonography (TRUS)-guided prostate needle biopsy (TRNB). During the same period, 82 consecutive clinically diagnosed prostate cancers were included as controls. The clinical and pathological features of the screened versus clinically diagnosed cancers were evaluated. A total of 719 (8.4%) of screened men had PSA levels ≥ 4.0 ng/ml. Biopsy was performed in 295 men, and 58 prostate cancers were detected. The biopsy rate, positive predictive value (PPV), and detection rate were 41.0, 19.7, and 0.68%, respectively. More screened patients were found with PSA levels <20 ng/ml (55.2 vs. 22.4%, P < 0.001), Gleason scores <7 (60.3 vs. 34.1%, P = 0.002), organ-confined tumors (87.9 vs. 26.8%, P < 0.001), and opportunities for radical prostatectomy (50.0 vs. 18.3%, P < 0.001) than that in clinically diagnosed patients. PSA screening is effective for early detection of prostate cancer in Chinese elderly men. Favorable PSA levels, Gleason scores, clinical stages, and chances for radical prostatectomy are associated with PSA screening. Further studies are needed to evaluate the effect of screening on treatment outcomes and mortality of prostate cancer in Chinese.
先前的研究表明，在中国实施 PSA 筛查至关重要。本研究比较了筛查发现和临床诊断的前列腺癌的临床和病理特征，并评估了 PSA 筛查对南京地区前列腺癌早期检测的效果。2004 年 7 月至 2005 年 12 月，共纳入 8562 名年龄≥50 岁的男性进行 PSA 筛查。血清 PSA≥4.0ng/ml 的参与者建议进行经直肠超声（TRUS）引导的前列腺针吸活检（TRNB）。同期纳入 82 例连续临床诊断的前列腺癌患者作为对照。评估了筛查与临床诊断的癌症的临床和病理特征。共有 849 名（9.9%）筛查男性的 PSA 水平≥4.0ng/ml。对 295 名男性进行了活检，检出 58 例前列腺癌。活检率、阳性预测值（PPV）和检出率分别为 41.0%、19.7%和 0.68%。筛查组发现更多的 PSA 水平<20ng/ml（55.2% vs. 22.4%，P<0.001）、Gleason 评分<7（60.3% vs. 34.1%，P=0.002）、器官局限肿瘤（87.9% vs. 26.8%，P<0.001）和根治性前列腺切除术机会（50.0% vs. 18.3%，P<0.001）的患者。PSA 筛查可有效检测中国老年男性的前列腺癌。有利的 PSA 水平、Gleason 评分、临床分期和根治性前列腺切除术机会与 PSA 筛查相关。需要进一步研究来评估筛查对中国前列腺癌的治疗效果和死亡率的影响。
