Departamento de Medicina, Faculdade de Medicina da Universidade Federal da Bahia, Salvador, BA, Brasil.
Divisão de Química Clínica, Fleury Medicina e Saúde, São Paulo, SP, Brasil.
Int Braz J Urol. 2019 May-Jun;45(3):478-485. doi: 10.1590/S1677-5538.IBJU.2018.0179.
To evaluate the trend of use of Prostate Specifi c Antigen (PSA) for screening of prostate cancer (PC) among Brazilian doctors, from the beginning of its regular availability in clinical laboratories.
A serial cross-sectional study was performed using data obtained from a large database between 1997 and 2016. The general PSA screening trend during this period, adjusted for the total number of exams performed in men, was analyzed. Time-series analysis was performed through observation of the general regression curve using the generalized least squares method, and the impact of the recommendations was assessed with autoregressive integrated moving average (ARIMA) models.
During the period studied 2,521,383 PSA determinations were done. The age of the participants ranged from 21 to 111 years, with an average of 56.7 ± 22.7 years. The relative number of PSA tests/100.000 exams in males showed a constant reduction since 2001, and this trend was more evident in the group aged 55-69 years. Although statistically signifi cant, the impact of reduced PSA screening after the 2012 USPSTF publication was clinically irrelevant.
Our results indicated a continuous reduction in the use of PSA screening over time, regardless of the publication of recommendations or clinical guidelines. The fact that this trend was more pronounced among those with a greater benefi t potential (55-69 years), relative to groups with a greater damage potential due to overdiagnosis and overtreatment (aged >74 years and < 40 years), is a matter of concern. Follow-up studies of these trends are advisable.
评估自前列腺特异性抗原（PSA）常规用于临床实验室以来，巴西医生对前列腺癌（PC）进行 PSA 筛查的使用趋势。
本研究采用了 1997 年至 2016 年间从大型数据库中获得的数据，进行了一项连续的横断面研究。分析了在此期间，针对男性接受的总检查次数对常规 PSA 筛查趋势进行了调整。通过使用广义最小二乘法观察总回归曲线，进行了时间序列分析，并使用自回归综合移动平均（ARIMA）模型评估了建议的影响。
在研究期间共进行了 2521383 次 PSA 测定。参与者的年龄从 21 岁到 111 岁不等，平均年龄为 56.7±22.7 岁。55-69 岁男性的 PSA 检测数/100000 检查数相对数自 2001 年以来呈持续下降趋势，且该趋势在该组中更为明显。尽管统计学上有意义，但 2012 年 USPSTF 发布后 PSA 筛查减少的影响在临床上并不重要。
无论发布推荐意见还是临床指南，我们的结果均表明，随着时间的推移，PSA 筛查的使用持续减少。与过度诊断和过度治疗导致潜在损害风险更大的人群（>74 岁和<40 岁）相比，这种趋势在潜在获益更大的人群（55-69 岁）中更为明显，这令人担忧。建议对这些趋势进行后续研究。
