University of Colorado Health Sciences Center, Denver, CO, USA.
J Clin Oncol. 2011 Feb 1;29(4):355-61. doi: 10.1200/JCO.2010.30.5979. Epub 2010 Nov 1.
Estimates of prostate cancer-specific mortality (PCSM) were similar for men randomly assigned to intervention compared with usual care on the Prostate, Lung, Colorectal and Ovarian PC screening study. However, results analyzed by comorbidity strata remain unknown.
Between 1993 and 2001, of 76,693 men who were randomly assigned to usual care or intervention at 10 US centers, 73,378 (96%) completed a questionnaire that inquired about comorbidity and prostate-specific antigen (PSA) testing before random assignment. Fine and Gray's multivariable analysis was performed to assess whether the randomized screening arm was associated with the risk of PCSM in men with no or minimal versus at least one significant comorbidity, adjusting for age and prerandomization PSA testing.
After 10 years of follow-up, 9,565 deaths occurred, 164 from PC. A significant decrease in the risk of PCSM (22 v 38 deaths; adjusted hazard ratio [AHR], 0.56; 95% CI, 0.33 to 0.95; P = .03) was observed in men with no or minimal comorbidity randomly assigned to intervention versus usual care, and the additional number needed to treat to prevent one PC death at 10 years was five. Among men with at least one significant comorbidity, those randomly assigned to intervention versus usual care did not have a decreased risk of PCSM (62 v 42 deaths; AHR, 1.43; 95% CI, 0.96 to 2.11; P = .08).
Selective use of PSA screening for men in good health appears to reduce the risk of PCSM with minimal overtreatment.
在前列腺、肺、结直肠和卵巢 PC 筛查研究中，与常规护理相比，随机分配到干预组的男性前列腺癌特异性死亡率（PCSM）估计值相似。然而，按合并症分层分析的结果仍不清楚。
1993 年至 2001 年，在 10 个美国中心，随机分配到常规护理或干预组的 76693 名男性中，有 73378 名（96%）完成了一份问卷，该问卷在随机分配前询问了合并症和前列腺特异性抗原（PSA）检测情况。采用 Fine 和 Gray 的多变量分析来评估在无或轻度合并症与至少有一项显著合并症的男性中，随机筛查组与 PCSM 风险之间的关系，调整年龄和随机前 PSA 检测。
10 年随访后，发生了 9565 例死亡，其中 164 例死于 PC。在无或轻度合并症的男性中，与常规护理相比，随机分配到干预组的男性 PCSM 风险显著降低（22 例与 38 例死亡；调整后的危险比 [AHR]，0.56；95%CI，0.33 至 0.95；P=0.03），预防 10 年内每例 PC 死亡所需的治疗人数为 5。在至少有一项显著合并症的男性中，与常规护理相比，随机分配到干预组的男性 PCSM 风险并未降低（62 例与 42 例死亡；AHR，1.43；95%CI，0.96 至 2.11；P=0.08）。
对于健康状况良好的男性，选择性使用 PSA 筛查似乎可以降低 PCSM 的风险，同时最小化过度治疗。
