Cupp M R, Oesterling J E
Department of Urology, Mayo Clinic, Rochester, MN 55905.
Mayo Clin Proc. 1993 Mar;68(3):297-306. doi: 10.1016/s0025-6196(12)60052-4.
In this article, we review the current status of early detection of prostate cancer. From existing data in the medical and urologic literature, we developed an algorithm that uses the three current methods of detection: digital rectal examination (DRE), determination of the prostate-specific antigen (PSA) value, and transrectal ultrasonography (TRUS). Prostatic malignant disease is an increasing medical problem in the United States. The potential for cure is optimized by early detection and treatment of organ-confined disease. Mass screening for prostate cancer in asymptomatic men cannot be advocated until a decrease in the mortality rate is established by randomized, controlled studies; however, these data will be unavailable for at least 15 years. In the meantime, clinicians must prudently use DRE, PSA, and TRUS for early detection. Current data indicate that the PSA level is as effective as or more effective than DRE for the detection of prostate cancer. These two methods do not always detect the same malignant tumor; therefore, the combined use of DRE and PSA testing provides a more complete evaluation of the prostate gland for malignant involvement. TRUS is more costly and does not add appreciable detectability when results of both the DRE and the PSA determination are normal. Thus, TRUS is best reserved for patients who have abnormal results of DRE or increased PSA values.
在本文中，我们回顾了前列腺癌早期检测的现状。根据医学和泌尿学文献中的现有数据，我们开发了一种算法，该算法使用三种当前的检测方法：直肠指检（DRE）、前列腺特异性抗原（PSA）值测定和经直肠超声检查（TRUS）。前列腺恶性疾病在美国是一个日益严重的医学问题。通过早期检测和治疗局限性疾病可使治愈的可能性最大化。在通过随机对照研究确定死亡率下降之前，不能提倡对无症状男性进行前列腺癌的大规模筛查；然而，这些数据至少15年内都无法获得。在此期间，临床医生必须谨慎使用DRE、PSA和TRUS进行早期检测。目前的数据表明，PSA水平在检测前列腺癌方面与DRE一样有效或更有效。这两种方法并不总是能检测到同一恶性肿瘤；因此，联合使用DRE和PSA检测能更全面地评估前列腺是否存在恶性病变。TRUS成本更高，而且当DRE和PSA测定结果均正常时，它并不能显著提高可检测性。因此，TRUS最好仅用于DRE结果异常或PSA值升高的患者。
