Department of Clinical Science, Intervention and Technology, Karolinska Institutet and Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet (UN), Stockholm, Sweden.
Department of Clinical Science, Intervention and Technology, Karolinska Institutet and Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet (UN), Stockholm, Sweden.
J Urol. 2018 Jul;200(1):82-88. doi: 10.1016/j.juro.2018.01.080. Epub 2018 Feb 1.
We evaluated the long-term effect of screening for prostate cancer.
In 1988 we randomly selected 2,400 men from a background population of 27,464 men. The 2,400 men were invited to undergo screening, of whom 1,779 (74%) accepted and were examined with digital rectal examination, ultrasound and prostate specific antigen measurement. Biopsy was performed if there were suspicious findings on ultrasound or digital rectal examination, or prostate specific antigen was greater than 10 ng/ml. The subpopulations have now been reassessed after 20 years.
Participants had a decreased overall mortality rate compared to the source population (IRR 0.93, 95% CI 0.86-0.98). Nonparticipants had an increased overall mortality rate (IRR 1.25, 95% CI 1.14-1.37). There was no difference between the groups in prostate cancer specific survival. The incidence of prostate cancer remained higher in the screened population throughout followup.
A single screening intervention in men 50 to 75 years old using prostate specific antigen, digital rectal examination and transrectal ultrasound, and a prostate specific antigen cutoff of 10 ng/ml for biopsy carried a significant risk of prostate cancer detection without a concomitant reduction in prostate cancer specific mortality after 20 years. This intervention should not be considered for public screening. Nonparticipants were at greater risk for death of all causes. In addition to being a single intervention trial, the limitations of this study include an outdated prostate specific antigen cutoff for biopsy. Despite the outdated screening method the source population failed to reach the same level of prostate cancer incidence as the screened population even after 20 years.
我们评估了前列腺癌筛查的长期效果。
1988 年，我们从 27464 名男性的背景人群中随机选择了 2400 名男性。邀请 2400 名男性进行筛查，其中 1779 名（74%）接受了检查，包括直肠指检、超声和前列腺特异性抗原测量。如果超声或直肠指检有可疑发现，或者前列腺特异性抗原大于 10ng/ml，则进行活检。20 年后，对亚人群进行了重新评估。
与原始人群相比，参与者的总体死亡率降低（IRR0.93，95%CI0.86-0.98）。非参与者的总体死亡率增加（IRR1.25，95%CI1.14-1.37）。两组在前列腺癌特异性生存率方面没有差异。在整个随访期间，筛查人群的前列腺癌发病率仍然较高。
在 50 至 75 岁的男性中，使用前列腺特异性抗原、直肠指检和经直肠超声进行单次筛查干预，以及将前列腺特异性抗原活检截断值设定为 10ng/ml，会显著增加前列腺癌的检出风险，但 20 年后并未降低前列腺癌特异性死亡率。这种干预措施不应被视为公共筛查。非参与者死于各种原因的风险更高。除了是一项单一干预试验外，本研究还存在一些局限性，包括活检的前列腺特异性抗原截断值已过时。尽管筛查方法已经过时，但即使在 20 年后，原始人群的前列腺癌发病率也未能达到筛查人群的水平。
