Roobol Monique J
Erasmus University Medical Centre, Department of Urology, Rotterdam, The Netherlands.
Expert Opin Med Diagn. 2013 Sep;7(5):423-6. doi: 10.1517/17530059.2013.821980. Epub 2013 Jul 23.
Before the 1980s, prostate cancer (PC) was considered a deadly disease. The mortality-incidence ratio showed that 1 out of each 2 - 3 PC patients died of this disease. On the other hand, autopsy studies have shown that latent PC is common in middle-aged men. The prostate-specific antigen (PSA), a glycoprotein produced by the epithelial cells of the prostate gland, received FDA's approval in 1986 for monitoring treatment response, and in 1994 as a screening aid for the diagnosis of PC. After the publication of two randomized trials on PC screening using the PSA test, it is generally accepted that systematic PSA-based screening, as compared to a clinical situation with virtually no screening, can reduce suffering from metastatic disease and PC mortality. However, what is also shown is that PSA-based screening coincides with a considerable amount of unnecessary testing and overdiagnosis. Should we abandon the use of the PSA test for the diagnosis of PC, or should we encourage PSA testing and make it freely available for all men at any time? Both the answers should be "No." What we must do is use the test as wisely as is currently possible and inform men, who want to be tested, in a balanced way about harms and potential benefits.
在20世纪80年代之前，前列腺癌被视为一种致命疾病。死亡率与发病率之比显示，每2至3名前列腺癌患者中就有1人死于该病。另一方面，尸检研究表明，潜伏性前列腺癌在中年男性中很常见。前列腺特异性抗原（PSA）是一种由前列腺上皮细胞产生的糖蛋白，1986年获得美国食品药品监督管理局（FDA）批准用于监测治疗反应，1994年获批作为前列腺癌诊断的筛查辅助手段。在两项关于使用PSA检测进行前列腺癌筛查的随机试验发表后，人们普遍认为，与几乎不进行筛查的临床情况相比，基于PSA的系统筛查可以减少转移性疾病的痛苦和前列腺癌死亡率。然而，研究还表明，基于PSA的筛查伴随着大量不必要的检测和过度诊断。我们应该放弃使用PSA检测来诊断前列腺癌，还是应该鼓励进行PSA检测并让所有男性随时都能免费进行检测呢？这两个答案都应该是否定的。我们必须做的是尽可能明智地使用该检测，并以平衡的方式告知想要接受检测的男性有关危害和潜在益处。
