Affiliations of authors: Department of Surgery and Perioperative Sciences, Urology and Andrology (PS, BH) and Department of Radiation Sciences, Oncology (HJ), Umeå University, Umeå, Sweden; Department of Surgery, Urology Service (PS, SC), Department of Epidemiology and Biostatistics (AV), Department of Laboratory Medicine (HL), Department of Surgery (HL), and Department of Medicine (HL), Memorial Sloan-Kettering Cancer Center, New York, NY; Department of Urology, Sahlgrenska Academy at Göteborg University, Göteborg, Sweden (SC, JH); Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK (HL); Institute of Biomedical Technology, University of Tampere, Tampere, Finland (HL); Department of Laboratory Medicine in Malmö, Lund University, Malmö, Sweden (HL).
J Natl Cancer Inst. 2014 Mar;106(3):dju007. doi: 10.1093/jnci/dju007. Epub 2014 Mar 7.
The effect of prostate-specific antigen (PSA) screening on prostate cancer mortality remains debated, despite evidence from randomized trials. We investigated the association between prostate cancer incidence, reflecting uptake of PSA testing, and prostate cancer mortality.
The study population consisted of all men aged 50 to 74 years residing in eight counties in Sweden with an early increase in prostate cancer incidence and six counties with a late increase during two time periods. Incidence of metastatic prostate cancer was investigated in the period from 2000 to 2009, and prostate cancer-specific mortality and excess mortality were investigated in the period from 1990 to 1999 and the period from 2000 to 2009 by calculating rate ratios for high- vs low-incidence counties and rate ratios for the period from 2000 to 2009 vs the period from 1990 to 1999 within these two groups. All statistical tests were two-sided.
There were 4528134 person-years at risk, 1577 deaths from prostate cancer, and 1210 excess deaths in men with prostate cancer in high-incidence counties and 2471373 person-years at risk, 985 prostate cancer deaths, and 878 excess deaths in low-incidence counties in the period from 2000 to 2009. Rate ratios in counties with high vs low incidence adjusted for time period were 0.81 (95% confidence interval [CI] = 0.73 to 0.90) for prostate cancer- specific mortality and 0.74 (95% CI = 0.64 to 0.86) for excess mortality, and the rate ratio of metastatic prostate cancer was 0.85 (95% CI = 0.79 to 0.92).
The lower prostate cancer mortality in high-incidence counties reflecting a high PSA uptake suggests that more-intense as compared with less-intense opportunistic PSA screening reduces prostate cancer mortality.
尽管随机试验提供了证据，但前列腺特异性抗原（PSA）筛查对前列腺癌死亡率的影响仍存在争议。我们研究了前列腺癌发病率（反映了 PSA 检测的采用情况）与前列腺癌死亡率之间的关联。
研究人群由居住在瑞典八个县（在两个时期内前列腺癌发病率早期上升）和六个县（在两个时期内前列腺癌发病率晚期上升）的 50 至 74 岁男性组成。在 2000 年至 2009 年期间，调查了转移性前列腺癌的发病率，通过计算高发县与低发县之间的发病率比和 2000 年至 2009 年期间与 1990 年至 1999 年期间之间的发病率比，来计算高发病率县和低发病率县之间的前列腺癌特异性死亡率和超额死亡率的比值，以及 2000 年至 2009 年期间与 1990 年至 1999 年期间之间的超额死亡率比值。所有统计检验均为双侧检验。
在高发县，2000 年至 2009 年期间有 4528134 人年处于发病风险中，有 1577 人死于前列腺癌，有 1210 人死于前列腺癌相关超额死亡，在低发县，2000 年至 2009 年期间有 2471373 人年处于发病风险中，有 985 人死于前列腺癌，有 878 人死于前列腺癌相关超额死亡。经时期调整后，高发病率县与低发病率县之间的前列腺癌特异性死亡率比值为 0.81（95%置信区间[CI] = 0.73 至 0.90），超额死亡率比值为 0.74（95% CI = 0.64 至 0.86），转移性前列腺癌的发病率比值为 0.85（95% CI = 0.79 至 0.92）。
发病率较高的县前列腺癌死亡率较低，这表明与轻度筛查相比，更强化的机会性 PSA 筛查可降低前列腺癌死亡率。
