Early Detection Research Group, Division of Cancer Prevention, National Cancer Institute, Bethesda, MD 20852, USA.
Acta Oncol. 2011 Jun;50 Suppl 1:12-7. doi: 10.3109/0284186X.2010.531283.
The Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial (PLCO) was conducted in sites around USA during a period of marked secular changes in the use of prostate specific antigen (PSA) screening for prostate cancer.
Trends in prostate cancer incidence, stage at presentation and mortality are useful when interpreting the results from a screening trial that commenced in 1993 and enrolled participants through 2001. The last participants completed active screening in 2006. Incidence and mortality data published to date on PLCO need to be placed into the context of the secular trends. Additional data analyses have been conducted on subsets of the participants and these results can also enhance the interpretation of the trial. Additionally, the accompanying biospecimen repository has served as a rich research resource yielding informative findings.
The PLCO is best viewed as a trial comparing a regimented active annual screening program of PSA screening for six rounds, four of which had accompanying digital rectal examination (DRE) to patterns of screening that were occurring in the population in many academic and community settings across the USA. The epidemiology and molecular genetics of prostate cancer is becoming better understood and analyses of the PLCO resource have contributed. One approach to risk assessment utilizing genetic markers from selected members of the PLCO prostate cancer cohort has been developed. A modeling effort with CISNET-ERSPC-PLCO is underway to compare and contrast findings such as effects of different PSA thresholds and screening intervals.
The information emerging from PLCO is useful to inform the debate around prostate cancer screening. An understanding of the biologic differences underpinning indolent and aggressive prostate cancer will better guide the future development of screening and treatment strategies.
前列腺、肺、结肠和卵巢癌筛查试验（PLCO）在美国各地的多个地点进行，在此期间，前列腺特异性抗原（PSA）筛查在前列腺癌筛查中的应用发生了明显的长期变化。
当解释于 1993 年开始并于 2001 年招募参与者的筛查试验的结果时，前列腺癌发病率、就诊时的分期和死亡率趋势非常有用。最后一批参与者于 2006 年完成了主动筛查。迄今为止，关于 PLCO 的发病率和死亡率数据需要结合长期趋势进行解读。对参与者的子组进行了额外的数据分析，这些结果也可以增强对试验的解释。此外，伴随的生物标本库已成为一个丰富的研究资源，产生了有意义的发现。
PLCO 最好被视为一项试验，将其与在许多美国学术和社区环境中发生的人群中进行的、有规律的年度主动筛查方案进行比较，该方案对六个轮次的 PSA 筛查进行了强化，其中四个轮次伴有数字直肠检查（DRE）。前列腺癌的流行病学和分子遗传学研究正在得到更好的理解，PLCO 资源的分析也有所贡献。利用来自 PLCO 前列腺癌队列中选定成员的遗传标记进行风险评估的方法已经开发出来。正在与 CISNET-ERSPC-PLCO 一起进行建模工作，以比较和对比不同 PSA 阈值和筛查间隔等发现的效果。
PLCO 提供的信息有助于为前列腺癌筛查的争论提供信息。对潜在惰性和侵袭性前列腺癌的生物学差异的理解将更好地指导未来的筛查和治疗策略的发展。
