Mettlin C, Murphy G P, Ray P, Shanberg A, Toi A, Chesley A, Babaian R, Badalament R, Kane R A, Lee F
Roswell Park Memorial Institute, Buffalo, New York 14263.
Cancer. 1993 Feb 1;71(3 Suppl):891-8. doi: 10.1002/1097-0142(19930201)71:3+<891::aid-cncr2820711405>3.0.co;2-x.
The American Cancer Society-National Prostate Cancer Detection Project is a prospective study of the feasibility of early prostate cancer detection by digital rectal examination (DRE), transrectal ultrasound (TRUS), and prostate specific antigen (PSA). Two thousand nine hundred ninety-nine men not previously suspected of having prostate cancer have been entered on study in ten participating clinical centers.
The study protocol requires these men to undergo testing with the three detection methods under investigation on an annual basis for up to 5 years. Data currently are available on 1972 men who have completed protocol requirements for two sequential series of examinations.
At the first visit, it was recommended that 16.5% of subjects undergo biopsy based on the TRUS and/or DRE findings. Seventy-three (3.7%) men were found to have cancer after the first series of examinations. When the 1899 men who did not have cancer were reexamined, in 11.4%, a biopsy was recommended, and an additional 33 (1.7%) cancers were detected. Cancer detection rates were higher in older men, and the sensitivity of TRUS was higher than that of DRE at both examinations. The positive predictive values (PPV) of TRUS and DRE varied significantly depending on the PSA level; PPV decreased at the second examination. Positive findings during the second examination were associated with elevated PSA levels during the earlier visit and rising PSA levels between examinations. Analyses of the 106 cancers detected currently showed a preponderance of early-stage cancer and low Gleason scores.
It may be possible to increase the early detection of prostate cancer by periodic examination by a combination of detection modalities.
美国癌症协会 - 国家前列腺癌检测项目是一项关于通过直肠指检（DRE）、经直肠超声（TRUS）和前列腺特异性抗原（PSA）进行早期前列腺癌检测可行性的前瞻性研究。2999名此前未被怀疑患有前列腺癌的男性已在10个参与研究的临床中心入组。
研究方案要求这些男性每年接受这三种正在研究的检测方法的检测，为期最长5年。目前已有1972名男性的数据，他们完成了两个连续系列检查的方案要求。
在首次就诊时，根据TRUS和/或DRE检查结果，建议16.5%的受试者进行活检。在第一轮检查后，发现73名（3.7%）男性患有癌症。当对1899名未患癌症的男性进行复查时，11.4%的人被建议进行活检，又检测出33例（1.7%）癌症。老年男性的癌症检出率更高；在两次检查中，TRUS的敏感性均高于DRE。TRUS和DRE的阳性预测值（PPV）因PSA水平而异；在第二次检查时PPV降低。第二次检查时的阳性结果与早期就诊时PSA水平升高以及两次检查之间PSA水平上升有关。对目前检测出的106例癌症的分析显示，早期癌症和低Gleason评分占多数。
通过联合使用多种检测方式进行定期检查，有可能提高前列腺癌的早期检测率。
