Agency for Healthcare Research and Quality, Rockville, Maryland 20850, USA.
Oncology (Williston Park). 2011 May;25(6):452-60, 463.
The ultimate utility of the serum prostate specific antigen (PSA) assay as a screening test for reducing prostate cancer mortality has been an area of intense controversy since its introduction. PSA testing was not initially envisioned as a screening tool, but as a way to evaluate treatment responses in men with prostate cancer. Far in advance of evidence from randomized trials, the rapid and widespread uptake of PSA screening into US practice was initially driven by the intuitively logical assumption that the earlier one detects a malignancy, the more likely treatment is to be curative while minimizing associated harms. However, a growing body of observational evidence began to point to a substantial burden of associated overdiagnosis and overtreatment triggered by PSA testing. The interim results of several randomized clinical trials specifically designed to evaluate the impact of PSA testing on prostate cancer mortality have recently become available, but their incongruent results seem to have added fuel to the debate. This article presents a review of the literature on screening for prostate cancer with PSA testing; we include a detailed discussion of potential explanations for the contradictory results of the two largest randomized trials as well as reflections on the future of prostate cancer screening.
血清前列腺特异性抗原（PSA）检测作为一种降低前列腺癌死亡率的筛查试验的最终用途一直是一个激烈争论的领域，自从它被引入以来。PSA 检测最初并不是作为一种筛查工具，而是作为一种评估前列腺癌患者治疗反应的方法。在随机试验的证据出现之前，PSA 筛查在美国的迅速和广泛采用最初是基于一个直观的逻辑假设，即越早发现恶性肿瘤，治疗就越有可能是治愈性的，同时最大限度地减少相关的危害。然而，越来越多的观察性证据开始指向由 PSA 检测引发的大量相关过度诊断和过度治疗。最近，几项专门设计用于评估 PSA 检测对前列腺癌死亡率影响的随机临床试验的中期结果已经公布，但它们不一致的结果似乎给争论火上浇油。本文对 PSA 检测筛查前列腺癌的文献进行了回顾；我们详细讨论了这两项最大的随机试验结果相互矛盾的潜在解释，以及对前列腺癌筛查未来的思考。
