Cher M L, Carroll P R
Department of Urology, University of California, San Francisco, School of Medicine, USA.
West J Med. 1995 Mar;162(3):235-42.
Prostate cancer is a serious health care problem in the United States. Whether or not to screen for it has become a timely issue. Although a large number of men have clinically important, asymptomatic, undetected prostate cancer, an even larger number have clinically unimportant cancer. To justify screening programs, not only must we avoid detecting biologically unimportant cancers, we must also detect and effectively treat that subset of tumors that, if undiagnosed, would progress, produce symptoms, and reduce life expectancy. Serum prostate-specific antigen (PSA) assay, or its variations such as PSA density, PSA velocity, and age-specific reference ranges, and the digital rectal examination are the best tests for detecting clinically important, asymptomatic, curable tumors. Recent data suggest that using serum PSA levels does not result in an overdetection of unimportant tumors. Highly effective, curative treatment of localized prostate cancer is available. These factors promote optimism that screening for prostate cancer will ultimately prove beneficial. Nonetheless, men should be informed regarding the benefits and possible risks before being screened for prostate cancer.
前列腺癌在美国是一个严重的医疗保健问题。是否进行筛查已成为一个紧迫的问题。尽管大量男性患有临床上具有重要意义的无症状、未被发现的前列腺癌，但更多的人患有临床上无重要意义的癌症。为了证明筛查计划的合理性，我们不仅必须避免检测到生物学上无重要意义的癌症，还必须检测并有效治疗那部分肿瘤，如果不进行诊断，这些肿瘤将会进展、产生症状并缩短预期寿命。血清前列腺特异性抗原（PSA）检测，或其变体如PSA密度、PSA速率以及年龄特异性参考范围，还有直肠指检是检测临床上具有重要意义的无症状、可治愈肿瘤的最佳检测方法。最近的数据表明，使用血清PSA水平不会导致对无重要意义肿瘤的过度检测。对于局限性前列腺癌有高效、可治愈的治疗方法。这些因素使人们乐观地认为，前列腺癌筛查最终将被证明是有益的。尽管如此，在对男性进行前列腺癌筛查之前，应告知他们相关的益处和可能的风险。
