Nuffield Department of Surgical Sciences, University of Oxford based at the Royal Hallamshire Hospital, Sheffield, UK.
BJU Int. 2011 Nov;108(9):1402-8. doi: 10.1111/j.1464-410X.2011.10163.x. Epub 2011 Apr 11.
OBJECTIVE • To estimate rates of prostate-specific antigen (PSA) testing in UK general practices by age, deprivation index and geographical location. SUBJECTS AND METHODS • Practice-based, retrospective data on PSA testing patterns in 2007 were collected from a random sample of 87 general practices using EMIS LV computer systems within the passively observed non-intervention arm of a cluster-randomized controlled trial. • Information for a total of 126 716 men aged 45-89 years with no recorded diagnosis of prostate cancer prior to 1 January 2007 was collected. RESULTS • In all, 7902 (6.2%) of 126 716 men aged 45-89 without a prior diagnosis of prostate cancer underwent at least one PSA test from their general practitioner during 2007 [95% confidence interval (CI) 5.6-7.0%; practice-based inter-quartile range 3.6-8.4%]. • PSA testing rates were 1.4% (95% CI 1.1-1.6%) in men aged 45-49, rising to 11.3% (95% CI 10.0-12.9%) at age 75-79 years (P for trend <0.001). • Testing rates were lowest in the three northern centres (3.5-5.7%) vs the three more southern centres (7.1-8.9%; P < 0.001). • For every 20 points increase in the index of multiple deprivation score, the proportion of men tested fell by 1.7% (95% CI -2.5 to -0.8%; P < 0.001). • Lower proportions of men were subsequently diagnosed with prostate cancer in practices testing more men (odds ratio for a one unit increase in the natural log of testing 0.76; 95% CI 0.60-0.97; P= 0.025). CONCLUSION • Overall levels of PSA testing in UK general practice remain low, but for those tested there are important variations by age, deprivation and geographical location that do not appear to reflect clinical need or the intention of current policy. • PSA testing in general practice is currently skewed towards older men, and current policy enabling all men to make an informed choice about PSA testing is not being effectively implemented as uptake clearly varies by socioeconomic status. • This reinforces the need for robust evidence regarding the costs and benefits of using the PSA test for the detection of localized prostate cancer in the UK, a full assessment of the health economic implications and a revision of the current policy.
目的 • 通过年龄、贫困指数和地理位置来评估英国常规医疗实践中前列腺特异性抗原（PSA）检测的比率。
对象和方法 • 采用回顾性研究，于 2007 年从使用 EMIS LV 计算机系统的 87 家常规医疗实践中随机抽取一个样本，收集了与一项群组随机对照试验中被动观察非干预组相关的、2007 年 PSA 检测模式的常规医疗实践数据。 • 共收集了 126716 名年龄在 45-89 岁之间、2007 年 1 月 1 日之前没有前列腺癌诊断记录的男性的信息。
结果 • 在所有年龄在 45-89 岁之间、2007 年期间没有接受过常规医生 PSA 检测的 126716 名男性中，共有 7902 人（6.2%）接受了检测[95%置信区间（CI）为 5.6-7.0%；常规医疗实践中四分位距为 3.6-8.4%]。 • PSA 检测率在 45-49 岁男性中为 1.4%（95%CI 1.1-1.6%），在 75-79 岁男性中上升至 11.3%（95%CI 10.0-12.9%）（P<0.001）。 • 在北部三个中心（3.5-5.7%），检测率低于南部三个中心（7.1-8.9%）（P<0.001）。 • 每增加 20 分的多重剥夺指数得分，接受检测的男性比例就会下降 1.7%（95%CI -2.5 至 -0.8%；P<0.001）。 • 在检测人数较多的常规医疗实践中，被诊断患有前列腺癌的男性比例较低（检测对数自然单位增加一个单位的比值比为 0.76；95%CI 0.60-0.97；P=0.025）。
结论 • 英国常规医疗实践中 PSA 检测的总体水平仍然较低，但对于接受检测的人群来说，年龄、贫困程度和地理位置存在重要差异，这些差异似乎并不反映临床需求或现行政策的意图。 • 常规医疗实践中的 PSA 检测目前偏向于老年男性，而当前允许所有男性就 PSA 检测做出知情选择的政策并未得到有效实施，因为接受度显然因社会经济地位而异。 • 这再次强调了在英国，需要针对 PSA 检测用于检测局限性前列腺癌的成本效益有强有力的证据，需要对健康经济学的影响进行全面评估，并修订现行政策。
