Department of Urology, Erasmus Medical Centre, Rotterdam, The Netherlands.
Eur J Cancer. 2010 Nov;46(17):3120-5. doi: 10.1016/j.ejca.2010.09.038.
Individual approaches to prostate cancer screening in European countries could occur as a result of individual decision taking, public health policies or the relevance of the prostate cancer problem determined by incidence and mortality in individual countries.
An attempt is made to analyse current literature with respect to factors that could influence the individual or country-wide preference for or against the use of PSA driven screening. To obtain background information the incidence and mortality of prostate cancer in the EU countries participating in the ERSPC study, as well as the results of a recent join-point analysis of prostate cancer mortality for the same countries are reviewed. In addition, the question whether geographic differences in incidence and mortality could influence the value of screening tests in the different countries is evaluated.
Our literature review shows large regional differences in incidence and mortality of prostate. Proportions of men testing positive with PSA values ⩾4.0 ng/ml and PPVs do not reflect these regional differences. Also, regional differences are not in line with negative outcomes for any ERSPC center in an exploratory analysis of prostate cancer mortality. In all centers a decrease of prostate cancer mortality at various degrees was seen. Differences in attitude may be visible in the join-point regression analysis which shows differences in mortality trends for some countries. Detection of T1c cancers in the control group is a measure of opportunistic screening (limitations addressed in the text). The differences reported may best reflect regional decision patterns. As far as the validity of PSA driven testing in countries with a different incidence and mortality is concerned, it seems that neither the levels nor the predictive value of PSA is influenced by such differences.
A number of factors are identified which may explain the different individual decisions and different levels of use of opportunistic screening in the different EU countries.
由于个体决策、公共卫生政策或个别国家的前列腺癌发病率和死亡率决定的前列腺癌问题的相关性，欧洲国家的前列腺癌筛查方法可能会有所不同。
试图分析目前的文献，以了解可能影响个体或国家对 PSA 驱动筛查的使用偏好或反对的因素。为了获得背景信息，审查了参与 ERSPC 研究的欧盟国家的前列腺癌发病率和死亡率，以及对同一国家前列腺癌死亡率的最近联合点分析结果。此外，评估了发病率和死亡率的地理差异是否会影响不同国家的筛查试验的价值。
我们的文献综述显示，前列腺癌的发病率和死亡率存在较大的地区差异。PSA 值 ⩾4.0ng/ml 的男性检测阳性比例和阳性预测值并不能反映这些地区差异。此外，在对前列腺癌死亡率的探索性分析中，各 ERSPC 中心的区域差异与任何不良结果均不相符。在所有中心，前列腺癌死亡率都在不同程度上有所下降。在联合点回归分析中可以看出态度上的差异，该分析显示了一些国家的死亡率趋势存在差异。在对照组中检测到 T1c 期癌症是机会性筛查的一种措施（文中提到了局限性）。报告的差异可能最好地反映了区域决策模式。就不同发病率和死亡率的国家中 PSA 驱动检测的有效性而言，PSA 的水平和预测值似乎都不受这些差异的影响。
确定了一些因素，这些因素可能解释了不同欧盟国家的不同个体决策和不同水平的机会性筛查使用情况。
