Williams R B, Boles M, Johnson R E
Medical College of Virginia, Virginia Commonwealth University, Richmond, USA.
Arch Fam Med. 1995 Apr;4(4):311-5. doi: 10.1001/archfami.4.4.311.
To examine prostate-specific antigen (PSA) as a screening test in randomly selected primary care practices.
Chart abstractions of a random selection of 552 men (age, > or = 50 years) and physician and practice-level surveys.
Fifty-eight randomly selected, nonteaching, non-governmental, primary care practices in a 43-county area in Virginia.
Documented evidence of PSA screening for asymptomatic male patients and physician self-report on regular (annual or biannual) use of PSA screening.
Of 496 asymptomatic men, 123 (25%) seen in a 1-year period had documentation of PSA screening. Sixty (50%) of 120 asymptomatic men with documentation of a health maintenance examination had a PSA screening, whereas only 63 (17%) of 376 men without health maintenance examination had a PSA screening (chi 2, P < .001), after adjusting for race, insurance status, and age. Comparison of PSA screening use before and after the November 1992 publication of the American Cancer Society guidelines on PSA screening revealed that PSA screening after the publication date was 26%, compared with 19% before the data (P = .045), adjusting for health maintenance examination and the length of time for which the patient was eligible for screening. Logistic regression on physician self-report of regular vs not regular PSA use found an odds ratio of 6.12 (95% confidence interval, 1.28 to 29.30) for influence of the guidelines and 0.96 (95% confidence interval, 0.93 to 0.99) for the proportion receiving Medicaid or uninsured in the practice.
Despite controversy over PSA as a screening test, PSA screening has now spread substantially in primary care practice.
在随机选取的基层医疗诊所中，检验前列腺特异性抗原（PSA）作为一种筛查检测手段的情况。
对552名男性（年龄≥50岁）进行随机抽样的病历摘要分析，以及针对医生和诊所层面的调查。
弗吉尼亚州43个县随机选取的58家非教学、非政府基层医疗诊所。
无症状男性患者PSA筛查的书面证据，以及医生关于定期（每年或每半年一次）使用PSA筛查的自我报告。
在496名无症状男性中，123名（25%）在1年期间有PSA筛查的记录。在120名有健康维护检查记录的无症状男性中，60名（50%）进行了PSA筛查，而在376名没有健康维护检查的男性中，只有63名（17%）进行了PSA筛查（卡方检验，P<.001），校正了种族、保险状况和年龄因素。比较1992年11月美国癌症协会关于PSA筛查指南发布前后的PSA筛查使用情况，结果显示，校正健康维护检查和患者符合筛查条件的时间长度后，发布日期之后的PSA筛查率为26%，而发布日期之前为19%（P=.045）。对医生关于是否定期使用PSA的自我报告进行逻辑回归分析发现，指南的影响比值比为6.12（95%置信区间，1.28至29.30），诊所中接受医疗补助或未参保患者比例的影响比值比为0.96（95%置信区间，0.93至0.99）。
尽管PSA作为一种筛查检测手段存在争议，但目前PSA筛查在基层医疗实践中已广泛开展。
