Smith Sabin, Wolanski Philippe
Department of Urology, Townsville Hospital, Douglas, Queensland, Australia.
ANZ J Surg. 2018 Jul-Aug;88(7-8):E589-E593. doi: 10.1111/ans.14275. Epub 2017 Nov 30.
To compare the incidence of newly diagnosed metastatic prostate cancer at an Australian facility pre- and post-publication of the United States Preventive Services Task Force (USPSTF) guidelines and subsequent amendment of the Royal Australian College of General Practitioners Preventive Activities in General Practice guidelines.
A retrospective analysis was undertaken by patients with newly diagnosed prostate cancer following transrectal ultrasound-guided biopsy between 2009 and 2014. Patients were divided into two even groups based on whether they had undergone their transrectal ultrasound biopsy pre- (2009-2011) or post- (2013-2014) publication of USPSTF guidelines. Metastatic disease was determined by computed tomography chest, abdomen, pelvis as well as nuclear medicine bone scan. A comparison in the incidence of newly diagnosed metastatic prostate cancer was made.
A total of 130 patients were allocated into each group. In the pre-USPSTF group, 23 out of 130 patients had newly diagnosed metastatic prostatic cancer (17.7%). In the post-USPSTF group, 41 out of 130 (31.5%) had newly diagnosed metastatic prostate cancer (P < 0.05). The mean and median prostate-specific antigen was 15.9 and 9.4 (pre-guideline group) and 33.0 and 9.8 (post-guideline group), respectively (P = 0.02). The post-guidelines group had a higher incidence of low-grade disease (Gleason <7), a decreased incidence of intermediate grade disease (Gleason 7) and a relatively unchanged incidence in high-risk disease (Gleason >7).
The incidence of newly diagnosed metastatic prostate cancer nearly doubled in patients referred to our Urology Department post-release of the USPSTF guidelines.
比较美国预防服务工作组（USPSTF）指南发布前后以及澳大利亚皇家全科医生学院《全科医疗预防活动指南》随后修订前后，一家澳大利亚机构中新诊断的转移性前列腺癌的发病率。
对2009年至2014年间经直肠超声引导活检后新诊断为前列腺癌的患者进行回顾性分析。根据患者经直肠超声活检是在美国预防服务工作组指南发布前（2009 - 2011年）还是发布后（2013 - 2014年），将患者分为两组。通过胸部、腹部、骨盆计算机断层扫描以及核医学骨扫描确定是否存在转移性疾病。对新诊断的转移性前列腺癌的发病率进行比较。
每组共分配130例患者。在美国预防服务工作组指南发布前的组中，130例患者中有23例新诊断为转移性前列腺癌（17.7%）。在美国预防服务工作组指南发布后的组中，130例中有41例（31.5%）新诊断为转移性前列腺癌（P < 0.05）。前列腺特异性抗原的均值和中位数在指南发布前组分别为15.9和9.4，在指南发布后组分别为33.0和9.8（P = 0.02）。指南发布后组低级别疾病（Gleason评分<7）的发病率较高，中级疾病（Gleason评分7）的发病率降低，高危疾病（Gleason评分>7）的发病率相对不变。
在美国预防服务工作组指南发布后，转诊至我们泌尿外科的患者中新诊断的转移性前列腺癌的发病率几乎翻了一番。
