Department of Public Health, Epidemiology and Biostatistics, University of Birmingham, Edgbaston, Birmingham, UK.
CMAJ. 2012 Feb 7;184(2):169-77. doi: 10.1503/cmaj.110600. Epub 2011 Dec 12.
The volume of published literature on the evaluation and use of tests for monitoring purposes is sparse. Our aim was to determine the extent to which recommendations for monitoring prostate-specific antigen to detect recurrent prostate cancer consider key factors that should inform rule-based strategies for monitoring.
We reviewed the recommendations made in clinical guidelines for the repeated measurement of prostate-specific antigen in men who have received primary treatment for localized prostate cancer. We assessed the guidelines using the Appraisal of Guidelines for Research and Evaluation Framework.
We identified guidelines and statements of best practice from nine organizations. We saw considerable inconsistency in recommendations for testing for prostate-specific antigen as a form of monitoring. Recommendations on when to test appeared to be almost exclusively determined using standard follow-up schedules rather than any scientific basis. Recommendations on when to take action were primarily based on consensus statements or retrospective case series. Eight of the nine guidelines acknowledged the potential presence of measurement variability, but they did not attempt to account for the effect of such variability on the interpretation of the results of tests for prostate-specific antigen. Many recommendations were made with few or no supporting references; however, a variety of papers were cited across guidelines. Of 48 papers cited, 29.1% (14/48) were reviews; the remaining 70.8% (34/48) of papers cited were primary studies.
A systematic approach to the development of monitoring schedules using prostate-specific antigen in guidelines for prostate cancer is lacking, due to inadequacies in the available evidence and its use.
关于监测目的的评估和检测的文献数量稀少。我们的目的是确定在多大程度上，监测前列腺特异性抗原以检测复发性前列腺癌的建议考虑了应告知监测规则策略的关键因素。
我们回顾了针对接受局部前列腺癌初始治疗的男性重复测量前列腺特异性抗原的临床指南中的建议。我们使用评估研究和评估框架对指南进行了评估。
我们从九个组织中确定了指南和最佳实践声明。我们看到在前列腺特异性抗原检测作为监测形式的建议中存在相当大的不一致性。测试时间的建议似乎几乎完全是基于标准随访时间表，而不是任何科学依据。采取行动的建议主要基于共识声明或回顾性病例系列。九个指南中的八个承认了测量变异性的潜在存在，但它们没有试图将这种变异性对前列腺特异性抗原检测结果的解释的影响考虑在内。许多建议都是在很少或没有支持参考的情况下提出的；然而，各种指南都引用了不同的论文。在引用的 48 篇论文中，29.1%（14/48）为综述；其余 70.8%（34/48）引用的论文为原始研究。
由于现有证据及其使用存在不足，指南中缺乏使用前列腺特异性抗原对监测方案进行系统开发的方法。
