University of Melbourne, Department of Surgery, Austin Health, Melbourne, Australia.
Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia.
Prostate Int. 2016 Mar;4(1):20-4. doi: 10.1016/j.prnil.2015.11.001. Epub 2015 Dec 8.
Approaches to prostate cancer (PCa) care have changed in recent years out of concern for overdiagnosis and overtreatment. Despite these changes, many patients continue to undergo some form of curative treatment and with a growing perception among multidisciplinary clinicians that more aggressive treatments are being favored. This study examines patterns of PCa care in Australia, focusing on current rates of screening and aggressive interventions that consist of high-dose-rate (HDR) brachytherapy and pelvic lymph node dissection (PLND).
Health services data were used to assess Australian men undergoing PCa screening and treatment from 2001 to 2014. Age-specific rates of prostate-specific antigen (PSA) screening were calculated. Ratios of radical prostatectomy (RP) with PLND to RP without PLND, and HDR brachytherapy to low-dose-rate (LDR) brachytherapy were determined by state jurisdictions.
From 2008, the rate of PSA screening trended downward significantly with year for all age ranges (P < 0.02) except men aged ≥ 85 (P = 0.56). PLND rates for 2008-2014 were lower than rates for 2001-2007 across all states and territories. From 2008 to 2014, PLND was performed ≥ 2.7 times more frequently in New South Wales and the Australian Capital Territory than in other jurisdictions. Since 2007, brachytherapy practice across Australia has evolved towards a relatively low use of HDR brachytherapy (ratio of HDR to LDR brachytherapy < 0.5 for all jurisdictions except the Australian Capital Territory).
Rates of PLND and HDR brachytherapy for PCa have declined in Australia, providing evidence for the effect of stage migration due to widespread PSA screening. Currently, PSA screening rates remain high among older men, which may expose them to unnecessary investigations and treatment-related morbidity.
近年来，由于对过度诊断和过度治疗的担忧，前列腺癌 (PCa) 的治疗方法发生了变化。尽管发生了这些变化，但许多患者仍继续接受某种形式的治愈性治疗，并且多学科临床医生越来越认为，更积极的治疗方法受到青睐。本研究检查了澳大利亚的 PCa 治疗模式，重点关注当前的筛查率和包括高剂量率 (HDR) 近距离放射治疗和盆腔淋巴结清扫术 (PLND) 在内的激进干预措施的使用率。
使用卫生服务数据评估了 2001 年至 2014 年间接受 PCa 筛查和治疗的澳大利亚男性。计算了前列腺特异性抗原 (PSA) 筛查的年龄特异性率。按州司法管辖区确定了根治性前列腺切除术 (RP) 联合 PLND 与 RP 不联合 PLND 以及 HDR 近距离放射治疗与低剂量率 (LDR) 近距离放射治疗的比率。
自 2008 年以来，除了年龄≥85 岁的男性（P=0.56）外，所有年龄段的 PSA 筛查率都随着时间的推移呈显著下降趋势（P<0.02）。2008-2014 年期间，所有州和地区的 PLND 率均低于 2001-2007 年。2008 年至 2014 年期间，新南威尔士州和澳大利亚首都领地进行 PLND 的频率比其他司法管辖区高 2.7 倍以上。自 2007 年以来，澳大利亚各地的近距离放射治疗实践已经朝着相对较少使用 HDR 近距离放射治疗的方向发展（除澳大利亚首都领地外，所有司法管辖区的 HDR 与 LDR 近距离放射治疗的比率均<0.5）。
澳大利亚的 PLND 和 HDR 近距离放射治疗使用率下降，为广泛 PSA 筛查导致的分期迁移效应提供了证据。目前，PSA 筛查率在老年男性中仍然很高，这可能使他们面临不必要的检查和与治疗相关的发病率。
