Bretton P R
Southwest Florida Urologic Associates, Fort Myers 33907.
South Med J. 1994 Jul;87(7):720-3. doi: 10.1097/00007611-199407000-00009.
In this study, 1,027 healthy men over age 40 were screened for prostate cancer with digital rectal examinations (DRE) and prostate-specific antigen (PSA) levels. Findings were abnormal in 189 (18%). PSA levels alone were abnormal (> 4.0 ng/mL) in 111 men (12%), 60 men (8%) had abnormal DRE and normal PSA, and 18 men had abnormal results of both examinations. Of the 189 men, 176 (93%) were referred for follow-up studies, and 39 cases of prostate cancer were detected. Of the 60 men with abnormal findings on DRE and normal PSA levels, only 2 men (3%) were found to have prostate cancer. Twenty-two of the 107 men (21%) with PSA levels between 4.0 and 9.9 ng/mL and 14 of 22 men (64%) with a PSA level greater than 10 ng/mL had prostate cancer. Conversely, 36 of the 39 men (92%) with prostate cancer had a PSA level greater than 4.0 ng/mL. Of 18 men with both abnormal DRE and elevated PSA, 9 (50%) were found to have prostate cancer. Overall, the 39 men found to have prostate cancer constituted 3.8% of the population screened; 25 of them (64%) had disease clinically confined to the prostate. PSA in combination with DRE appears to be useful in detecting prostate cancer in its early stages. Prospective randomized trials must be completed to determine whether early detection will have an impact on overall mortality from prostate cancer.
在本研究中，对1027名40岁以上的健康男性进行了前列腺癌筛查，检查项目包括直肠指检（DRE）和前列腺特异性抗原（PSA）水平检测。189人（18%）的检查结果异常。仅PSA水平异常（>4.0 ng/mL）的有111人（12%），60人（8%）直肠指检异常但PSA正常，18人两项检查结果均异常。在这189人中，176人（93%）被转诊进行后续研究，共检测出39例前列腺癌。在直肠指检异常但PSA水平正常的60人中，仅2人（3%）被发现患有前列腺癌。PSA水平在4.0至9.9 ng/mL之间的107名男性中有22人（21%）患有前列腺癌，PSA水平大于10 ng/mL的22名男性中有14人（64%）患有前列腺癌。相反，在39例前列腺癌患者中，36人（92%）的PSA水平大于4.0 ng/mL。在直肠指检和PSA均异常的18人中，9人（50%）被发现患有前列腺癌。总体而言，发现的39例前列腺癌患者占筛查人群的3.8%；其中25人（64%）的疾病临床局限于前列腺。PSA联合直肠指检似乎有助于早期检测前列腺癌。必须完成前瞻性随机试验，以确定早期检测是否会对前列腺癌的总体死亡率产生影响。
