Tampere School of Public Health, University of Tampere, Tampere, Finland.
Eur Urol. 2012 May;61(5):1011-8. doi: 10.1016/j.eururo.2012.01.008. Epub 2012 Jan 14.
Population-based screening for prostate cancer (PCa) has used serum prostate-specific antigen (PSA) since the early 1990s. However, the efficacy could be affected by screening interval, age ranges of screening, attendance, and contamination of the control group in randomised controlled trials.
Assess the impact of the above-mentioned factors on screening efficacy.
DESIGN, SETTING, AND PARTICIPANTS: Parameters pertaining to the natural history of PCa and sensitivity were estimated using data from the Finnish quadrennial screening program starting at 55 yr of age and terminating at 71 yr of age and comprising 80 458 men (32 000 in the screening arm and 48 458 in the control arm). We performed Markov decision analyses for different screening policies with a simulated 25-yr follow-up.
PSA screening.
The impact of different interscreening intervals and target age ranges on advanced PCa (stage III or worse) and PCa mortality was assessed.
With 65% attendance and 20% contamination, as in the Finnish trial, screening would result in an 11.1% (95% confidence interval [CI], 9.1-13.3%) reduction in advanced cancers and a 7.3% (95% CI, 5.3-9.7%) reduction in PCa death, with corresponding absolute risk difference of 2.6% (95% CI, 1.9-3.5%) and 1.8% (95% CI, 1.4-2.2%), respectively. Numbers needed to screen were 385 to prevent one case of advanced PCa and 556 to prevent one PCa death at 25 yr. Those figures remained similar from 12 yr onwards. Reduction in advanced PCa increased to 40% with annual screening and to 24% with biennial screening. When the age at screening initiation was increased by 5 yr, the benefit was reduced by 9% with annual screening and by 3% with biennial screening.
We predicted the impact of basic screening characteristics on the benefit of the program. The screening interval (1-4 yr) had a greater impact on mortality reduction than did the age at start of screening (55-65 yr).
International Standard Randomised Controlled Trial Number (ISRCTN): ISRCTN49127736.
自 20 世纪 90 年代初以来，基于人群的前列腺癌（PCa）筛查一直使用血清前列腺特异性抗原（PSA）。然而，在随机对照试验中，筛查间隔、筛查年龄范围、参与率和对照组的污染都可能影响筛查效果。
评估上述因素对筛查效果的影响。
设计、地点和参与者：使用芬兰四年一次的筛查计划的数据，从 55 岁开始，至 71 岁结束，涉及 80458 名男性（筛查组 32000 名，对照组 48458 名），估算与 PCa 自然史和敏感性相关的参数。我们对不同的筛查策略进行了 Markov 决策分析，模拟了 25 年的随访。
PSA 筛查。
评估不同的筛查间隔和目标年龄范围对晚期前列腺癌（III 期或更差）和前列腺癌死亡率的影响。
在芬兰试验中，假设参与率为 65%，对照组污染率为 20%，筛查将使晚期癌症减少 11.1%（95%置信区间[CI]，9.1-13.3%），前列腺癌死亡减少 7.3%（95%CI，5.3-9.7%），相应的绝对风险差异为 2.6%（95%CI，1.9-3.5%）和 1.8%（95%CI，1.4-2.2%）。每筛查 385 人可预防 1 例晚期 PCa，每筛查 556 人可预防 1 例 PCa 死亡，25 年时的预期风险分别为 2.6%（95%CI，1.9-3.5%）和 1.8%（95%CI，1.4-2.2%）。这些数字从 12 年后基本保持不变。如果每年进行筛查，那么晚期 PCa 的减少率将增加到 40%，如果每两年进行一次筛查，减少率将增加到 24%。如果筛查起始年龄增加 5 岁，每年筛查的获益减少 9%，每两年筛查的获益减少 3%。
我们预测了基本筛查特征对项目效益的影响。筛查间隔（1-4 年）对死亡率降低的影响大于筛查起始年龄（55-65 岁）。
国际标准随机对照试验注册（ISRCTN）号：ISRCTN49127736。
