Tuppin Philippe, Leboucher Claire, Peyre-Lanquar Gabrielle, Lamy Pierre-Jean, Gabach Pierre, Rébillard Xavier
Caisse nationale d'assurance maladie des travailleurs salariés, 75986 Paris cedex 20, France.
Caisse nationale d'assurance maladie des travailleurs salariés, 75986 Paris cedex 20, France.
Presse Med. 2017 Oct;46(10):e237-e247. doi: 10.1016/j.lpm.2017.04.015. Epub 2017 Oct 12.
In 2010, the French Haute Autorité de santé (National Health Authority) confirmed the limited value of prostate cancer (PCa) screening by total prostate-specific antigen (PSA) assay.
This study was designed to determine the modalities of ordering total PSA or free PSA assays (in the absence of PCa) according to various parameters and the corresponding sums reimbursed.
Men aged 40 years and older covered by the national health insurance general scheme (73% of the French population) between 2012 and 2014 were selected. Data were derived from the Système national d'information inter-régimes de l'assurance maladie (Sniiram) (National health insurance information system) database.
In 2014, 27% of the 11.6 million men 40 years and older underwent at least one total PSA assay and 5.6% underwent at least one free PSA assay, with marked variations according to the presence or absence of treated lower urinary tract symptoms (LUTS) (53% and 15% vs 24% and 5%) and from one administrative department to another. The peak total PSA assay rate was observed between the ages of 65 and 74 years: 64% of men with LUTS, 46% without LUTS. Between 2012 and 2014, men in whom at least one PSA assay had been performed underwent a mean of 1.8 total PSA assays and 1.7 free PSA assays, with means of 2.3 and 2, respectively, in the presence of LUTS. General practice specialists ordered 91% of the PSA tests reimbursed in 2014 (92% for total PSA and 87% for free PSA) and urologists ordered 4% of reimbursed tests. The total sum reimbursed was €28.5 million, comprising €8.7 million for free PSA. An average of 10 laboratory tests was performed at the same time as the PSA assay in the absence of treated LUTS.
Total PSA and free PSA assays are performed in a large number of men, although the value of these tests as first-line test before biopsy remains controversial. These PSA assays are associated with many other laboratory tests looking for possible abnormalities, especially in younger men, and their relevance may therefore not be specifically discussed with the patient.
2010年，法国卫生高级管理局（国家卫生管理机构）证实了通过总前列腺特异性抗原（PSA）检测进行前列腺癌（PCa）筛查的价值有限。
本研究旨在根据各种参数确定订购总PSA或游离PSA检测（在无PCa的情况下）的方式以及相应的报销金额。
选取2012年至2014年间参加国家医疗保险一般计划（覆盖73%的法国人口）的40岁及以上男性。数据来源于国家医疗保险信息系统（Sniiram）数据库。
2014年，在1160万40岁及以上男性中，27%的人至少进行了一次总PSA检测，5.6%的人至少进行了一次游离PSA检测，根据是否存在经治疗的下尿路症状（LUTS）有显著差异（53%和15%对比24%和5%），且不同行政区之间也存在差异。总PSA检测率在65至74岁之间达到峰值：有LUTS的男性中为64%，无LUTS的男性中为46%。2012年至2014年间，至少进行过一次PSA检测的男性平均进行了1.8次总PSA检测和1.7次游离PSA检测，有LUTS时分别为2.3次和2次。2014年，91%的报销PSA检测由全科医生开具（总PSA为92%，游离PSA为87%），泌尿科医生开具了4%的报销检测。报销总额为2850万欧元，其中游离PSA为870万欧元。在无经治疗的LUTS的情况下，平均每次PSA检测同时还会进行10项实验室检测。
尽管总PSA和游离PSA检测作为活检前一线检测的价值仍存在争议，但大量男性进行了这些检测。这些PSA检测还会伴随许多其他寻找可能异常情况的实验室检测，尤其是在年轻男性中，因此可能不会与患者具体讨论其相关性。
