Imai K, Kubota Y, Yamanaka H
Dept. of Urology, Gunma University School of Medicine, Japan.
Gan To Kagaku Ryoho. 1994 Sep;21(12):1923-7.
Prostate specific antigen (PSA), digital rectal examination (DRE) and transrectal ultrasonography (TRUS) are widely used for the detection of prostate cancer. The sensitivity and positive predictive value of PSA are most excellent among these modalities. However, the sensitivity of PSA was 73% when the cut off value was 6ng/ml. In the general clinical practice the use of three screening modalities must be recommended to improve the detection rate. However, the mass screening which has to diagnose many subjects during a short period should be mainly conducted by PSA, because blood sampling for PSA was performed with other kind of mass screening without any specialists (urologists). We are now investigating the effects of age specific PSA and PSA velocity to improve the sensitivity of PSA. It is estimated that the prostate cancer death and the prevalence will rapidly increase in Japan. Therefore, we had better start the preventative research including mass screening. To prove the significance of mass screening program, pilot studies in well executed randomized prospective protocols are urgently needed.
前列腺特异性抗原（PSA）、直肠指检（DRE）和经直肠超声检查（TRUS）被广泛用于前列腺癌的检测。在这些检查方法中，PSA的敏感性和阳性预测值最为出色。然而，当临界值为6纳克/毫升时，PSA的敏感性为73%。在一般临床实践中，必须推荐使用这三种筛查方法以提高检出率。然而，在短时间内要诊断众多对象的大规模筛查应以PSA为主，因为PSA血液采样可与其他类型的大规模筛查同时进行，无需任何专科医生（泌尿科医生）。我们目前正在研究年龄特异性PSA和PSA速率对提高PSA敏感性的影响。据估计，日本前列腺癌死亡人数和患病率将迅速上升。因此，我们最好开展包括大规模筛查在内的预防研究。为证明大规模筛查计划的重要性，迫切需要在精心实施的随机前瞻性方案中进行试点研究。
