Potosky A L, Miller B A, Albertsen P C, Kramer B S
Applied Research Branch, National Cancer Institute, Bethesda, Md 20892-7344.
JAMA. 1995 Feb 15;273(7):548-52.
To assess the reasons for the dramatic surge in prostate cancer incidence from 1986 to 1991.
Population-based study of incidence rates and procedures used to detect and diagnose prostate cancer derived from Medicare claims data and the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program from 1986 to 1991.
Four SEER areas (Connecticut; Atlanta, Ga; Detroit, Mich; and Seattle--Puget Sound, Wash) covering approximately 6% of the US population.
A 5% random sample of male fee-for-service Medicare beneficiaries aged 65 years and older without cancer, and all men with prostate cancer diagnosed at 65 years of age and older residing in the four areas.
The age-adjusted rates of prostate cancer incidence, prostate needle biopsy, transurethral resection of the prostate, serum prostate-specific antigen (PSA) testing, and transrectal ultrasound.
The age-adjusted incidence rate of prostate cancer among men aged 65 years and older in the four SEER areas rose 82% from 1986 to 1991, with the largest annual increases occurring in 1990 (20%) and 1991 (19%). Prostate needle biopsy rates increased while the use of transurethral resection of the prostate declined from 1986 to 1991. The rising needle biopsy rate has been driven by an exponential increase in PSA testing in the general population from 1988 to 1991 and, to a much lesser extent, the increasing use of transrectal ultrasound since 1986. The use of PSA or transrectal ultrasound has increased across age and race groups and in different geographic areas. However, there remain wide geographic variations in the use of PSA screening.
The recent dramatic epidemic of prostate cancer is likely the result of the increasing detection of tumors resulting from increased PSA screening. The magnitude and rapidity of the incidence rise suggest that changes in the intensity of medical surveillance is the most plausible explanation for this trend.
The rapid diffusion of screening interventions that have the ability to detect latent asymptomatic disease leads to important concerns regarding costs and patient quality of life for men aged 65 years and older. Geographic variability in the adoption of PSA testing underscores uncertainty and disagreement about its value for reducing prostate cancer mortality. More research is required to determine the effectiveness of screening for prostate cancer.
评估1986年至1991年前列腺癌发病率急剧上升的原因。
基于人群的发病率及用于检测和诊断前列腺癌的程序的研究，数据来源于医疗保险索赔数据以及1986年至1991年美国国立癌症研究所的监测、流行病学和最终结果（SEER）项目。
四个SEER地区（康涅狄格州；佐治亚州亚特兰大市；密歇根州底特律市；华盛顿州西雅图 - 普吉特海湾地区），覆盖约6%的美国人口。
65岁及以上无癌症的按服务收费的男性医疗保险受益人的5%随机样本，以及居住在这四个地区的所有65岁及以上被诊断患有前列腺癌的男性。
前列腺癌发病率、前列腺穿刺活检、经尿道前列腺切除术、血清前列腺特异性抗原（PSA）检测及经直肠超声检查的年龄调整率。
1986年至1991年，四个SEER地区65岁及以上男性前列腺癌的年龄调整发病率上升了82%，年度增幅最大的是1990年（20%）和1991年（19%）。1986年至1991年，前列腺穿刺活检率上升，而经尿道前列腺切除术的使用率下降。穿刺活检率上升是由1988年至1991年普通人群中PSA检测呈指数增长以及自1986年以来经直肠超声检查使用量在较小程度上增加所驱动。PSA或经直肠超声检查的使用在各年龄和种族组以及不同地理区域均有所增加。然而，PSA筛查的使用在地理上仍存在很大差异。
近期前列腺癌的急剧流行可能是PSA筛查增加导致肿瘤检测增多的结果。发病率上升的幅度和速度表明医疗监测强度的变化是对此趋势最合理的解释。
能够检测潜在无症状疾病的筛查干预措施的迅速传播引发了对65岁及以上男性成本和患者生活质量的重要担忧。PSA检测采用情况的地理差异凸显了对其降低前列腺癌死亡率价值的不确定性和分歧。需要更多研究来确定前列腺癌筛查的有效性。
