Morse R M, Resnick M I
Case Western Reserve University School of Medicine, Cleveland, Ohio.
Urol Clin North Am. 1990 Aug;17(3):567-74.
A large number of cases of prostatic carcinoma are discovered unexpectedly by simple prostatectomy performed for presumed benign disease. The ability to discover these cancers preoperatively is an appealing concept, in other words, to screen: the use of a test to detect a disease in an asymptomatic individual. The ideal screening test would be noninvasive, inexpensive, reliable, and reproducible. It would also have a high sensitivity and specificity, neither allowing a disease process to be missed by a falsely negative result nor leading to unnecessary and more invasive studies by a falsely positive one. It has been suggested that an acceptable screening test have a sensitivity of at least 95 per cent and a specificity of 100 per cent. An equally important criterion for a successful screening program for cancer has to do with the biologic potential of the discovered malignancy. The adage is that more men die with prostate cancer than of prostate cancer. However, the biologic potential of prostate cancer has not been fully elucidated, and it is not entirely clear who will benefit from treatment and who should be left alone. At the present time, noninvasive imaging modalities and biochemical markers are not clinically useful in detecting occult prostatic carcinoma. Furthermore, no study has proved that routine screening reduces the mortality rate from prostate cancer. Many authors believe that screening men for prostate cancer should be regarded as investigational and that currently, only screening programs for breast and cervical cancer have been fully demonstrated to be effective. New studies are needed that include control groups who are not subjected to the early diagnostic modality, assessing both the disadvantages of the screening program and the potential benefits.
大量前列腺癌病例是在因假定为良性疾病而进行的简单前列腺切除术中意外发现的。术前发现这些癌症的能力是一个很有吸引力的概念，换句话说，就是进行筛查：使用一种检测方法在无症状个体中检测疾病。理想的筛查检测应是非侵入性的、廉价的、可靠的且可重复的。它还应具有高灵敏度和特异性，既不会因假阴性结果而漏诊疾病进程，也不会因假阳性结果导致不必要的更具侵入性的检查。有人建议，可接受的筛查检测灵敏度至少应为95%，特异性应为100%。癌症成功筛查计划的一个同样重要的标准与所发现恶性肿瘤的生物学潜能有关。俗话说，死于前列腺癌的男性比因前列腺癌死亡的男性更多。然而，前列腺癌的生物学潜能尚未完全阐明，目前还不完全清楚谁将从治疗中受益以及谁应不予治疗。目前，非侵入性成像模式和生化标志物在检测隐匿性前列腺癌方面在临床上并无用处。此外，尚无研究证明常规筛查能降低前列腺癌的死亡率。许多作者认为，对男性进行前列腺癌筛查应被视为试验性的，目前只有乳腺癌和宫颈癌的筛查计划已被充分证明是有效的。需要开展新的研究，纳入未接受早期诊断方法的对照组，评估筛查计划的弊端和潜在益处。
