Oregon Health & Science University, Portland, Oregon 97239, USA.
Ann Intern Med. 2011 Dec 6;155(11):762-71. doi: 10.7326/0003-4819-155-11-201112060-00375. Epub 2011 Oct 7.
Screening can detect prostate cancer at earlier, asymptomatic stages, when treatments might be more effective.
To update the 2002 and 2008 U.S. Preventive Services Task Force evidence reviews on screening and treatments for prostate cancer.
MEDLINE (2002 to July 2011) and the Cochrane Library Database (through second quarter of 2011).
Randomized trials of prostate-specific antigen-based screening, randomized trials and cohort studies of prostatectomy or radiation therapy versus watchful waiting, and large observational studies of perioperative harms.
Investigators abstracted and checked study details and quality using predefined criteria.
Of 5 screening trials, the 2 largest and highest-quality studies reported conflicting results. One found that screening was associated with reduced prostate cancer-specific mortality compared with no screening in a subgroup of men aged 55 to 69 years after 9 years (relative risk, 0.80 [95% CI, 0.65 to 0.98]; absolute risk reduction, 0.07 percentage point). The other found no statistically significant effect after 10 years (relative risk, 1.1 [CI, 0.80 to 1.5]). After 3 or 4 screening rounds, 12% to 13% of screened men had false-positive results. Serious infections or urine retention occurred after 0.5% to 1.0% of prostate biopsies. There were 3 randomized trials and 23 cohort studies of treatments. One good-quality trial found that prostatectomy for localized prostate cancer decreased risk for prostate cancer-specific mortality compared with watchful waiting through 13 years of follow-up (relative risk, 0.62 [CI, 0.44 to 0.87]; absolute risk reduction, 6.1%). Benefits seemed to be limited to men younger than 65 years. Treating approximately 3 men with prostatectomy or 7 men with radiation therapy instead of watchful waiting would each result in 1 additional case of erectile dysfunction. Treating approximately 5 men with prostatectomy would result in 1 additional case of urinary incontinence. Prostatectomy was associated with perioperative death (about 0.5%) and cardiovascular events (0.6% to 3%), and radiation therapy was associated with bowel dysfunction.
Only English-language articles were included. Few studies evaluated newer therapies.
Prostate-specific antigen-based screening results in small or no reduction in prostate cancer-specific mortality and is associated with harms related to subsequent evaluation and treatments, some of which may be unnecessary.
Agency for Healthcare Research and Quality.
筛查可以在无症状的早期阶段检测前列腺癌，此时治疗可能更为有效。
更新 2002 年和 2008 年美国预防服务工作组（U.S. Preventive Services Task Force）关于前列腺癌筛查和治疗的证据综述。
MEDLINE（2002 年至 2011 年 7 月）和 Cochrane 图书馆数据库（截至 2011 年第二季度）。
基于前列腺特异性抗原的筛查的随机试验、前列腺切除术或放射治疗与观察等待的随机试验和队列研究，以及围手术期危害的大型观察性研究。
调查人员使用预先确定的标准提取和检查研究细节和质量。
在 5 项筛查试验中，最大和质量最高的两项研究报告了相互矛盾的结果。一项研究发现，与不筛查相比，在年龄为 55 至 69 岁的男性亚组中，筛查与前列腺癌特异性死亡率降低相关，9 年后的相对风险为 0.80（95%CI，0.65 至 0.98）；绝对风险降低 0.07 个百分点。另一项研究发现，10 年后没有统计学意义的效果（相对风险，1.1 [CI，0.80 至 1.5]）。经过 3 或 4 次筛查后，12%至 13%的筛查男性出现假阳性结果。前列腺活检后 0.5%至 1.0%会发生严重感染或尿潴留。有 3 项随机试验和 23 项队列研究治疗方法。一项高质量的试验发现，与观察等待相比，局限性前列腺癌的前列腺切除术降低了前列腺癌特异性死亡率的风险，随访 13 年的相对风险为 0.62（CI，0.44 至 0.87）；绝对风险降低 6.1%。益处似乎仅限于 65 岁以下的男性。每治疗约 3 名接受前列腺切除术或 7 名接受放射治疗的男性，而不是观察等待，就会使 1 例勃起功能障碍的额外病例。每治疗约 5 名接受前列腺切除术的男性，就会导致 1 例尿失禁。前列腺切除术与围手术期死亡（约 0.5%）和心血管事件（0.6%至 3%）有关，放射治疗与肠道功能障碍有关。
只纳入了英语文章。很少有研究评估新的治疗方法。
基于前列腺特异性抗原的筛查导致前列腺癌特异性死亡率的降低很小或没有降低，并且与随后的评估和治疗相关的危害有关，其中一些可能是不必要的。
美国医疗保健研究与质量署。
