School of Medicine, University of Tsukuba, Tsukuba, Japan.
Prostate Int. 2014 Mar;2(1):19-25. doi: 10.12954/PI.13035. Epub 2014 Mar 30.
We conducted the present retrospective study to elucidate regional differences in the quality of secondary screening in the prostate cancer (PCA) screening program by a local municipality in Japan.
Of 115,881 men who attended the PCA screening in 36 municipalities between 2001 and 2011, a total of 6,099 men consulted hospitals for secondary screening. The cancer detection rate (CDR) at the secondary screening was calculated, and municipalities were classified into three CDR groups according to the age-adjusted observed-to-expected ratios of CDR. Of the secondary screening facilities, hospitals in Ibaraki Prefecture screening less than 100 patients were classified as group I facilities and the others as group II facilities.
Overall, 2,320 of 6,099 secondary screening patients underwent prostate biopsy, and 1,073 men were diagnosed with PCA. The overall CDR at the secondary screening was 17.6%, but it varied from 5.6% to 34.4% among municipalities. Although there were no significant differences in age and prostate-specific antigen (PSA) distribution among the three CDR groups, a significantly higher rate of patients in low CDR municipalities visited group I facilities. Both biopsy rates and CDRs of secondary screening at group II facilities were significantly higher than those of group I facilities (P=0.0001). Multivariate analysis showed that the secondary screening at group II facilities as well as age and PSA levels were independent contributing factors for PCA detection.
CDRs at secondary screening varied widely among municipalities in Ibaraki Prefecture. Variation in CDRs was associated with biopsy rates.
本研究回顾性分析了日本某地方政府前列腺癌（PCA）筛查项目中二次筛查的质量在地域上的差异。
在 2001 年至 2011 年间，共有 115881 名男性参加了 36 个市的 PCA 筛查，其中共有 6099 名男性到医院进行了二次筛查。计算了二次筛查的癌症检出率（CDR），并根据 CDR 的年龄调整观察到的预期比值，将各自治市分为三组。在二次筛查机构中，茨城县筛查少于 100 名患者的医院被归类为组 I 机构，其余为组 II 机构。
共有 6099 名二次筛查患者中的 2320 名接受了前列腺活检，1073 名男性被诊断为 PCA。二次筛查的总体 CDR 为 17.6%，但在各自治市之间从 5.6%到 34.4%不等。尽管三组 CDR 之间的年龄和前列腺特异性抗原（PSA）分布无显著差异，但低 CDR 自治市的患者中，更多的人选择了组 I 机构就诊。组 II 机构的活检率和二次筛查的 CDR 均明显高于组 I 机构（P=0.0001）。多变量分析显示，组 II 机构的二次筛查以及年龄和 PSA 水平是 PCA 检出的独立影响因素。
茨城县各自治市的二次筛查 CDR 差异很大。CDR 的差异与活检率有关。
