Department of Family Medicine, University of Texas Medical Branch, Galveston, TX 77555-0177, USA.
J Gerontol A Biol Sci Med Sci. 2013 Jan;68(1):56-61. doi: 10.1093/gerona/gls135. Epub 2012 May 4.
The study assessed the impact of prostate-specific antigen (PSA) testing in the United States by comparing the rates of PSA testing in U.S. counties to the rates of prostate biopsies and newly treated prostate cancer and to deaths from prostate cancer.
We examined the association between the percentage of men aged 66-74 from a nationally representative 5% Medicare sample who received PSA testing in each U.S. county in 1997 and the percent of men who received prostate biopsies or treatment for newly diagnosed prostate cancer in 1997 as well as mortality from prostate cancer and from all other causes from 1998 to 2007.
Analyses of 1,067 U.S. counties showed a significant relationship between the rate of PSA testing and both the rate of men undergoing treatment for prostate cancer and prostate cancer mortality (both p < .001) but no relationship with mortality from other causes. For every 100,000 men receiving a PSA test in 1997, an additional 4,894 men underwent prostate biopsy and 1,597 additional men underwent prostate cancer treatment in 1997, and 61 fewer men died from prostate cancer during 1998-2006. Analyses stratified by age and race produced similar results.
PSA testing was associated with modest reductions in prostate cancer mortality and large increases in the number of men overdiagnosed with and overtreated for prostate cancer. The results are similar to those obtained by the large European randomized prospective trial of PSA testing.
本研究通过比较美国各郡前列腺特异性抗原（PSA）检测率与前列腺活检率、新诊断前列腺癌治疗率以及前列腺癌死亡率，评估了 PSA 检测在美国的影响。
我们检测了美国 1997 年全国性的 5%医疗保险抽样中 66-74 岁男性中，每个郡接受 PSA 检测的男性百分比与 1997 年接受前列腺活检或新诊断前列腺癌治疗的男性百分比以及 1998 年至 2007 年前列腺癌和其他所有原因死亡率之间的关联。
对 1067 个美国郡的分析表明，PSA 检测率与前列腺癌治疗率和前列腺癌死亡率之间存在显著关系（均 p <.001），但与其他原因死亡率之间无关系。与 1997 年每 100,000 名接受 PSA 检测的男性相比，1997 年额外有 4,894 名男性接受了前列腺活检，额外有 1,597 名男性接受了前列腺癌治疗，在 1998 年至 2006 年期间，有 61 名男性死于前列腺癌。按年龄和种族分层的分析得出了相似的结果。
PSA 检测与前列腺癌死亡率的适度降低以及被过度诊断和过度治疗的前列腺癌男性人数的大量增加有关。这些结果与大型欧洲随机前瞻性 PSA 检测试验的结果相似。
