Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Eur Urol. 2023 Oct;84(4):426-434. doi: 10.1016/j.eururo.2023.03.016. Epub 2023 Apr 5.
Considering the long natural history of prostate cancer (PCa), long-term results of the European Randomised Study of Screening for PCa (ERSPC) are crucial.
To provide an update on the effect of prostate-specific antigen (PSA)-based screening on PCa-specific mortality (PCSM), metastatic disease, and overdiagnosis in the Dutch arm of the ERSPC.
DESIGN, SETTING, AND PARTICIPANTS: Between 1993 and 2000, a total of 42376 men, aged 55-74 yr, were randomised to a screening or a control arm. The main analysis was performed with men aged 55-69 yr (n = 34831). Men in the screening arm were offered PSA-based screening with an interval of 4 yr.
Intention-to-screen analyses with Poisson regression were used to calculate rate ratios (RRs) of PCSM and metastatic PCa.
After a median follow-up of 21 yr, the RR of PCSM was 0.73 (95% confidence interval [CI]: 0.61-0.88) favouring screening. The numbers of men needed to invite (NNI) and needed to diagnose (NND) to prevent one PCa death were 246 and 14, respectively. For metastatic PCa, the RR was 0.67 (95% CI: 0.58-0.78) favouring screening. The NNI and NND to prevent one metastasis were 121 and 7, respectively. No statistical difference in PCSM (RR of 1.18 [95% CI: 0.87-1.62]) was observed in men aged ≥70 yr at the time of randomisation. In the screening arm, higher rates of PCSM and metastatic disease were observed in men who were screened only once and in a selected group of men above the screening age cut-off of 74 yr.
The current analysis illustrates that with a follow-up of 21 yr, both absolute metastasis and mortality reduction continue to increase, resulting in a more favourable harm-benefit ratio than demonstrated previously. These data do not support starting screening at the age of 70-74 yr and show that repeated screening is essential.
Prostate-specific antigen-based prostate cancer screening reduces metastasis and mortality. Longer follow-up shows fewer invitations and diagnoses needed to prevent one death, a positive note towards the issue of overdiagnosis.
考虑到前列腺癌（PCa）的自然病史较长，欧洲前列腺癌筛查研究（ERSPC）的长期结果至关重要。
提供基于前列腺特异性抗原（PSA）的筛查对荷兰 ERSPC 中 PCa 特异性死亡率（PCSM）、转移性疾病和过度诊断的影响的最新信息。
设计、地点和参与者：1993 年至 2000 年间，共有 42376 名 55-74 岁的男性被随机分配到筛查组或对照组。主要分析包括 55-69 岁的男性（n=34831）。筛查组的男性接受了基于 PSA 的筛查，间隔 4 年。
采用泊松回归的意向性筛查分析计算 PCSM 和转移性 PCa 的率比（RR）。
中位随访 21 年后，PCSM 的 RR 为 0.73（95%置信区间[CI]：0.61-0.88），支持筛查。为预防一例 PCa 死亡所需邀请的人数（NNI）和诊断的人数（NND）分别为 246 和 14。对于转移性 PCa，RR 为 0.67（95%CI：0.58-0.78），支持筛查。预防一次转移所需的 NNI 和 NND 分别为 121 和 7。在随机分组时年龄≥70 岁的男性中，PCSM 的 RR 无统计学差异（1.18[95%CI：0.87-1.62]）。在筛查组中，仅筛查一次和筛查年龄截止值 74 岁以上的男性中，PCSM 和转移性疾病的发生率较高。
目前的分析表明，在 21 年的随访后，绝对转移和死亡率的降低仍在继续，这导致了比以前更有利的危害效益比。这些数据不支持从 70-74 岁开始筛查，并表明重复筛查是必要的。
基于前列腺特异性抗原的前列腺癌筛查可降低转移和死亡率。更长时间的随访显示，预防一例死亡所需的邀请和诊断人数减少，这是对过度诊断问题的积极说明。
