Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, 1102F McGavran Greenberg Hall CB 7411, Chapel Hill, NC 27599, USA.
Cancer Causes Control. 2010 Jul;21(7):1071-80. doi: 10.1007/s10552-010-9535-4. Epub 2010 Mar 24.
This study examined PSA screening interval of black and white men aged 65 or older and its association with prostate cancer stage at diagnosis.
SEER-Medicare data were examined for 18,067 black and white men diagnosed with prostate cancer between 1994 and 2002. Logistic regression was used to assess the association between race, PSA screening interval, and stage at diagnosis. Analysis also controlled for age, marital status, comorbidity, diagnosis year, geographic region, income, and receipt of surgery.
Compared to whites, blacks diagnosed with prostate cancer were more likely to have had a longer PSA screening interval prior to diagnosis, including a greater likelihood of no pre-diagnosis use of PSA screening. Controlling for PSA screening interval was associated with a reduction in blacks' relative odds of being diagnosed with advanced (stage III or IV) prostate cancer, to a point that the stage at diagnosis was not statistically different from that of whites (OR=1.12, 95% CI=0.98-1.29). Longer intra-PSA intervals were systematically associated with greater odds of diagnosis with advanced disease.
More frequent or systematic PSA screening may be a pathway to reducing racial differences in prostate cancer stage at diagnosis, and, by extension, mortality.
本研究考察了 65 岁及以上的黑人和白人男性的 PSA 筛查间隔及其与诊断时前列腺癌分期的关系。
对 1994 年至 2002 年间诊断患有前列腺癌的 18067 名黑人和白人的 SEER-医疗保险数据进行了检查。使用逻辑回归评估种族、PSA 筛查间隔和诊断时的分期之间的关联。分析还控制了年龄、婚姻状况、合并症、诊断年份、地理区域、收入和手术情况。
与白人相比，黑人诊断出前列腺癌的可能性更大，在诊断前的 PSA 筛查间隔更长，包括不太可能进行过 PSA 筛查。控制 PSA 筛查间隔与黑人被诊断为晚期（III 期或 IV 期）前列腺癌的相对几率降低有关，以至于诊断时的分期与白人没有统计学差异（OR=1.12，95%CI=0.98-1.29）。PSA 间隔时间越长，诊断为晚期疾病的几率就越大。
更频繁或系统的 PSA 筛查可能是减少前列腺癌诊断时种族差异的途径，并进而降低死亡率。
