Seikkula Heikki A, Kaipia Antti J, Rantanen Matti E, Pitkäniemi Janne M, Malila Nea K, Boström Peter J
a Department of Surgery , Central Hospital of Central Ostrobothnia , Kokkola , Finland.
b Department of Urology , Turku University Hospital, University of Turku , Turku , Finland.
Acta Oncol. 2017 Jul;56(7):971-977. doi: 10.1080/0284186X.2017.1288298. Epub 2017 Feb 13.
The early diagnosis and right treatment strategy of localized prostate cancer (PCa) remains problematic. In order to characterize the survival of PCa patients, we compared patients' all-cause and cancer-specific mortalities between pre- and post-PSA periods by stage in Finland.
All PCa cases diagnosed in Finland between 1985 and 2013 (N = 91,329) were identified from the Finnish Cancer Registry (FCR). PCa stage at diagnosis was defined as localized, local node positive or metastasized. Standardized mortality ratios (SMRs), and relative and cause-specific survival were assessed by stage and introduction of PSA testing. The main limitation was the high proportion of men with unknown stage (28%).
A clear decreasing trend in the SMR of PCa patients was evident when pre- and post-PSA eras were compared: for localized PCa, the SMR was 1.43 (95%CI 1.38-1.48) in 1985-1989 and 0.98 (95%CI 0.95-1.01) in 2000-2004, and for metastasized PCa, the SMRs were 4.51 (95%CI 4.30-4.72) and 3.01 (95%CI 2.89-3.12), respectively. Difference between cause-specific and relative survival was pronounced in localized PCa in post-PSA period: 10-year relative survival was 94.6% (95%CI 91.4-97.8) and cause-specific 84.2% (95%CI 82.9-85.5%). In metastasized PCa the difference was not that significant.
From 1985 to 2009, the SMR among men diagnosed with PCa decreased significantly in Finland. Among men with localized PCa, the SMR decreased even below that of the Finnish male population. This and the increased difference between relative and cause-specific survival reflects most likely selection of men to opportunistic PSA testing. The results highlight the importance of caution in the use of PSA testing in healthy men.
局限性前列腺癌（PCa）的早期诊断和正确治疗策略仍然存在问题。为了描述PCa患者的生存情况，我们在芬兰按分期比较了前列腺特异性抗原（PSA）检测前后患者的全因死亡率和癌症特异性死亡率。
从芬兰癌症登记处（FCR）识别出1985年至2013年在芬兰诊断的所有PCa病例（N = 91329）。诊断时的PCa分期定义为局限性、局部淋巴结阳性或转移。通过分期和PSA检测的引入评估标准化死亡率（SMR）、相对生存率和病因特异性生存率。主要局限性是分期未知的男性比例较高（28%）。
比较PSA检测前后的时期，PCa患者的SMR有明显下降趋势：对于局限性PCa，1985 - 1989年的SMR为1.43（95%CI 1.38 - 1.48），2000 - 2004年为0.98（95%CI 0.95 - 1.01）；对于转移性PCa，SMR分别为4.51（95%CI 4.30 - 4.72）和3.01（95%CI 2.89 - 3.12）。在PSA检测后的时期，局限性PCa的病因特异性生存率和相对生存率之间的差异显著：10年相对生存率为94.6%（95%CI 91.4 - 97.8），病因特异性生存率为84.2%（95%CI 82.9 - 85.5%）。在转移性PCa中，差异不那么显著。
1985年至2009年，芬兰诊断为PCa的男性的SMR显著下降。在局限性PCa男性中，SMR甚至降至低于芬兰男性人群。这以及相对生存率和病因特异性生存率之间差异的增加最有可能反映了男性选择机会性PSA检测的情况。结果强调了在健康男性中谨慎使用PSA检测的重要性。
