Danish Cancer Society Research Center , Copenhagen , Denmark.
Acta Oncol. 2013 Nov;52(8):1609-14. doi: 10.3109/0284186X.2013.831474. Epub 2013 Aug 27.
Social differences in prostate cancer (PC) incidence and mortality might be related to testing for prostate-specific antigen (PSA). Although routine PSA screening is not recommended in Denmark, testing without clinical indication increased during the past decade. We evaluated associations between socio-demographic or clinical characteristics and PSA testing without clinical indication.
In the Danish Diet, Cancer and Health Cohort, we identified 1051 men with PC diagnosed in 1993-2008. Diagnostic and clinical characteristics were obtained from medical records, and socio-demographic information was retrieved from administrative registers. We used general logistic regression analysis to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for associations between socio-demographic or clinical characteristics and PSA testing without clinical indication. Cox regression analysis was used to examine associations with mortality.
PSA testing without clinical indication was less likely among patients > 67 years (OR 0.7; 0.5-1.0). Men who were, PSA tested without clinical indication, were more likely to have vocational training (OR 1.8; 1.1-2.9) or higher education (OR 1.5; 0.9-2.5) and less likely to have advanced disease (OR 0.6; 0.4-0.9). PSA testing without clinical indication more often preceded therapy with curative intent (OR 1.8; 1.1-2.9) and less often palliative treatment (OR 0.6; 0.3-1.0). Men who were PSA tested without clinical indication had non-significantly lower overall and PC-specific mortality [hazard ratios 0.8 (0.5-1.2) and 0.6 (0.3-1.1), respectively].
PSA testing without clinical indication was associated with higher educational level. PC detected by PSA testing with no clinical indication was more often localized and treated with curative intent.
前列腺癌（PC）发病率和死亡率的社会差异可能与前列腺特异性抗原（PSA）检测有关。尽管丹麦不推荐常规 PSA 筛查，但在过去十年中，无临床指征的检测有所增加。我们评估了社会人口统计学或临床特征与无临床指征的 PSA 检测之间的关联。
在丹麦饮食、癌症和健康队列中，我们确定了 1993-2008 年间诊断出的 1051 名 PC 患者。诊断和临床特征从病历中获得，社会人口统计学信息从行政登记中检索。我们使用一般逻辑回归分析来估计社会人口统计学或临床特征与无临床指征的 PSA 检测之间的比值比（OR）和 95%置信区间（CI）。Cox 回归分析用于检查与死亡率的关联。
67 岁以上患者进行无临床指征 PSA 检测的可能性较低（OR 0.7；0.5-1.0）。进行无临床指征 PSA 检测的男性更有可能接受职业培训（OR 1.8；1.1-2.9）或接受高等教育（OR 1.5；0.9-2.5），并且不太可能患有晚期疾病（OR 0.6；0.4-0.9）。无临床指征 PSA 检测更常先于有治愈意图的治疗（OR 1.8；1.1-2.9），不太可能进行姑息治疗（OR 0.6；0.3-1.0）。无临床指征 PSA 检测的男性总体和 PC 特异性死亡率均较低，但无统计学意义[风险比分别为 0.8（0.5-1.2）和 0.6（0.3-1.1）]。
无临床指征的 PSA 检测与较高的教育水平有关。无临床指征的 PSA 检测发现的 PC 更常为局部病变，并接受有治愈意图的治疗。
