Translational Oncology & Urology Research, Comprehensive Cancer Centre, King's College London, 3rd Floor, Bermondsey Wing, Guy's Hospital, London, SE1 9RT, UK.
University of South Australia, Centre for population Health Research Adelaide Australia, Adelaide, Australia.
BMC Urol. 2019 Aug 5;19(1):73. doi: 10.1186/s12894-019-0502-4.
Patient-related factors such as concern about cancer are believed to influence both men's decisions to undergo prostate specific antigen (PSA) testing and to have definitive treatment if diagnosed with low risk prostate cancer (PCa). The potential link between screening frequency and choice of active surveillance (AS) for low risk disease has not been studied previously. Our aim was to investigate whether there is any association between PCa screening frequency or previous negative prostate biopsy and uptake of AS among men with low risk PCa.
This register-based study included all men ≤75 years from Stockholm who were diagnosed with low risk PCa from 2008 to 2014 (n = 4336). Pre-diagnostic PSA testing and biopsy histories were obtained from the Stockholm PSA and Biopsy Register, a population-based register for the Stockholm country. The association between previous screening/biopsy history and AS uptake (based on primary treatment recorded in the National Prostate Cancer Register) was examined using multivariable logistic regression.
Forty seven percent of men with low risk PCa underwent AS. Uptake was associated with older age, very low risk disease, more recent diagnosis and absence of family history. None of the screening/biopsy measures (testing frequency, mean interval, PSA velocity, highest pre-diagnostic PSA or prior negative biopsy) were associated with uptake of AS among men with low risk PCa. Generalisability to settings with different policies and practices may be limited.
We found no evidence that screening frequency and negative biopsy influence uptake of AS among Swedish men with low risk PCa. Further research is required to determine factors that still present barriers for men taking up AS.
人们认为，与患者相关的因素，如对癌症的担忧，会影响男性进行前列腺特异性抗原（PSA）检测的决定，以及如果被诊断出患有低危前列腺癌（PCa）时进行确定性治疗的决定。之前尚未研究过筛查频率与低危疾病选择主动监测（AS）之间的潜在联系。我们的目的是调查 PCa 筛查频率或之前的阴性前列腺活检与低危 PCa 男性接受 AS 之间是否存在任何关联。
这项基于登记的研究包括来自斯德哥尔摩的所有≤75 岁的男性，他们在 2008 年至 2014 年间被诊断出患有低危 PCa（n=4336）。通过斯德哥尔摩 PSA 和活检登记处获得了诊断前 PSA 检测和活检史，该登记处是斯德哥尔摩地区的一个基于人群的登记处。使用多变量逻辑回归检查了既往筛查/活检史与 AS 接受率（基于国家前列腺癌登记处记录的主要治疗方法）之间的关联。
47%的低危 PCa 男性接受了 AS。AS 的接受率与年龄较大、极低危疾病、较近的诊断和无家族史有关。在低危 PCa 男性中，没有任何筛查/活检指标（检测频率、平均间隔、PSA 速度、最高诊断前 PSA 或先前的阴性活检）与 AS 的接受率相关。其推广到具有不同政策和实践的环境可能受到限制。
我们没有发现筛查频率和阴性活检会影响瑞典低危 PCa 男性接受 AS 的证据。需要进一步研究确定仍然存在障碍的因素，以便男性接受 AS。
