Aslani Afshin, Minnillo Brian J, Johnson Ben, Cherullo Edward E, Ponsky Lee E, Abouassaly Robert
Department of Urology, Case Western Reserve University, Urological Institute, University Hospitals Case Medical Center, Cleveland, Ohio.
Department of Urology, Case Western Reserve University, Urological Institute, University Hospitals Case Medical Center, Cleveland, Ohio.
J Urol. 2014 Jun;191(6):1737-42. doi: 10.1016/j.juro.2013.12.010. Epub 2013 Dec 14.
The United States Preventive Services Task Force recently recommended against routine prostate cancer screening, stating that the risks of screening outweigh the benefits. We determined the impact of this recommendation on prostate cancer screening in a large health system.
We obtained data on all screening prostate specific antigen tests performed at University Hospitals Case Medical Center and affiliated hospitals in northeastern Ohio from January 2008 to December 2012. We examined the total number of prostate specific antigen tests ordered with time and adjusted for patient volume by fitting a regression line. The overall trend was examined and stratified by location (urban, suburban or rural), patient age and provider type (primary care or urology).
A total of 43,498 screening prostate specific antigen tests were performed from January 2008 to December 2012. Most tests were ordered by specialists in internal medicine (64.9%), followed by family medicine (23.7%), urology (6.1%) and hematology/oncology (1.3%). Prostate specific antigen screening increased with time until March 2009, when initial screening trials were published. Prostate specific antigen testing then decreased significantly and continued to decrease after the task force recommendations. Similar patterns were noted in almost all subgroups. The greatest decrease in screening was observed by urologists and in patients in the intermediate age group (50 to 59 years).
United States Preventive Services Task Force recommendations appeared to have decreased prostate cancer screening. The greatest impact was seen for urologists and patients in the intermediate age group. Further study is needed to determine the long-term effects of these recommendations on the screening, diagnosis, treatment and prognosis of this prevalent malignancy.
美国预防服务工作组最近建议不要进行常规前列腺癌筛查，称筛查的风险大于益处。我们确定了这一建议对一个大型医疗系统中前列腺癌筛查的影响。
我们获取了2008年1月至2012年12月在大学医院凯斯医疗中心及俄亥俄州东北部附属医院进行的所有前列腺特异性抗原筛查检测的数据。我们检查了随时间订购的前列腺特异性抗原检测总数，并通过拟合回归线对患者数量进行了调整。按地点（城市、郊区或农村）、患者年龄和提供者类型（初级保健或泌尿外科）对总体趋势进行了检查和分层。
2008年1月至2012年12月共进行了43498次前列腺特异性抗原筛查检测。大多数检测由内科专家开出（64.9%），其次是家庭医学（23.7%）、泌尿外科（6.1%）和血液学/肿瘤学（1.3%）。前列腺特异性抗原筛查随时间增加，直到2009年3月首次筛查试验发表。此后前列腺特异性抗原检测显著下降，并在工作组建议后继续下降。几乎所有亚组都观察到类似模式。泌尿外科医生和中年组（50至59岁）患者的筛查下降幅度最大。
美国预防服务工作组的建议似乎减少了前列腺癌筛查。对泌尿外科医生和中年组患者的影响最大。需要进一步研究以确定这些建议对这种常见恶性肿瘤的筛查、诊断、治疗和预后的长期影响。
