Gilfrich Christian, May Matthias, Braun Kay-Patrick, Lebentrau Steffen, Lehsnau Mike, Ecke Thorsten, Schmailzl Kurt J G, Al-Dumaini Salah, Hallmann Steffen, Ahmed Ali M, Maurer Julia, Karl Thomas, Braun Vittoria, Haferkamp Axel, Brookman-May Sabine, Bauer Ricarda M, Stief Christian G, Hoschke Bernd, Maurer Odilo, Wolff Ingmar
Urologische Klinik, St. Elisabeth-Klinikum, Straubing, Germany.
Urol Int. 2014;93(2):160-9. doi: 10.1159/000356367. Epub 2014 Mar 5.
The aim of this cross-sectional study was to evaluate the value of prostate-specific antigen (PSA) testing as a tool for early detection of prostate cancer (PCa) applied by general practitioners (GPs) and internal specialists (ISs) as well as to assess criteria leading to the application of PSA-based early PCa detection.
Between May and December 2012, a questionnaire containing 16 items was sent to 600 GPs and ISs in the federal state Brandenburg and in Berlin (Germany). The independent influence of several criteria on the decision of GPs and ISs to apply PSA-based early PCa detection was assessed by multivariate logistic regression analysis (MLRA).
392 evaluable questionnaires were collected (return rate 65%). 81% of the physicians declared that they apply PSA testing for early PCa detection; of these, 58 and 15% would screen patients until the age of 80 and 90 years, respectively. In case of a pathological PSA level, 77% would immediately refer the patient to a urologist, while 13% would re-assess elevated PSA levels after 3-12 months. Based on MLRA, the following criteria were independently associated with a positive attitude towards PSA-based early PCa detection: specialisation (application of early detection more frequent for GPs and hospital-based ISs) (OR 3.12; p < 0.001), physicians who use exclusively GP or IS education (OR 3.95; p = 0.002), and physicians who recommend yearly PSA assessment after the age of 50 (OR 6.85; p < 0.001).
GPs and ISs frequently apply PSA-based early PCa detection. In doing so, 13% would initiate specific referral to a urologist in case of pathological PSA values too late. Improvement of this situation could possibly result from specific educational activities for non-urological physicians active in fields of urological core capabilities, which should be guided by joint boards of the national associations of urology and general medicine.
本横断面研究旨在评估全科医生（GPs）和内科专家（ISs）应用前列腺特异性抗原（PSA）检测作为早期发现前列腺癌（PCa）工具的价值，并评估导致应用基于PSA的早期PCa检测的标准。
2012年5月至12月期间，向德国勃兰登堡州和柏林的600名全科医生和内科专家发送了一份包含16项内容的问卷。通过多因素逻辑回归分析（MLRA）评估了几个标准对全科医生和内科专家应用基于PSA的早期PCa检测决策的独立影响。
收集到392份可评估问卷（回复率65%）。81%的医生表示他们应用PSA检测进行早期PCa检测；其中，分别有58%和15%的医生会对80岁和90岁以下的患者进行筛查。如果PSA水平异常，77%的医生会立即将患者转诊给泌尿科医生，而13%的医生会在3至12个月后重新评估升高的PSA水平。基于MLRA，以下标准与对基于PSA的早期PCa检测的积极态度独立相关：专科类型（全科医生和医院内科专家更频繁地应用早期检测）（比值比3.12；p<0.001）、仅接受全科医生或内科专家教育的医生（比值比3.95；p = 0.002）以及建议50岁后每年进行PSA评估的医生（比值比6.85；p<0.001）。
全科医生和内科专家经常应用基于PSA的早期PCa检测。在此过程中，13%的医生在PSA值异常时将患者转诊给泌尿科医生的时间过晚。对于活跃于泌尿外科核心能力领域的非泌尿外科医生开展特定的教育活动，可能会改善这种情况，这应由国家泌尿外科和普通医学协会的联合委员会指导。
