Mettlin C, Murphy G P, Lee F, Littrup P J, Chesley A, Babaian R, Badalament R, Kane R A, Mostofi F K
Roswell Park Cancer Institute, Buffalo, NY 14263.
Cancer. 1993 Sep 1;72(5):1701-8. doi: 10.1002/1097-0142(19930901)72:5<1701::aid-cncr2820720534>3.0.co;2-e.
Few data are available to describe the clinical and pathologic characteristics of prostate cancers detected through early detection programs. The American Cancer Society National Prostate Cancer Detection Project (ACS-NPCDP) is a multimodality, multicenter study of the feasibility of early prostate cancer detection using digital rectal examination (DRE), transrectal ultrasound (TRUS), and prostate specific antigen (PSA). One hundred fifty-six prostate cancers are available from this project for analysis.
The ACS-NPCDP is a prospective, comparative study of a cohort of 2,999 men between 55 and 70 years of age not suspected of having prostate cancer. DRE, TRUS, and PSA are performed for each subject on an annual basis for as long as 5 years. Biopsies are performed on the basis of recommendations from DRE or TRUS results. Although elevated PSA alone was not typically a basis for biopsy, in some instances biopsies were recommended because of the degree of elevation in PSA. Diagnoses are confirmed by participating pathologists and by pathologic analysis.
A small proportion of cancers detected were advanced in terms of the clinical stage at time of diagnosis. A total of only six cancers were stage C1 to D1, and five of these were preexisting cancers detected at the first examination. Cancers detected by DRE tended to be more advanced than those found on the basis of only TRUS or PSA. A large proportion of patients received curative therapy, involving radical prostatectomy for 67.9% and radiation therapy for 17.9%. Of 100 men presumed to have organ confined disease and treated by prostatectomy, 64 actually proved to have localized cancer, a rate of upstaging of 36.0%. PSA level and PSA density were associated with the detection of organ confined cancer, but several advanced cancers had PSA levels in the normal range, limiting the usefulness of these measures for staging.
The cancers resulting from this multimodality detection effort represented a spectrum of pathologic findings. These data, however, suggest that early detection interventions in men not suspected to have prostate cancer will yield tumors with a favorable stage distribution that are likely to benefit from treatment. Further follow-up evaluation is needed to determine whether these benefits are reflected in long-term mortality and survival experience.
关于通过早期检测项目发现的前列腺癌的临床和病理特征，可用数据较少。美国癌症协会国家前列腺癌检测项目（ACS-NPCDP）是一项多模式、多中心研究，旨在探讨使用直肠指检（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的可行性。该项目有156例前列腺癌可供分析。
ACS-NPCDP是一项对2999名年龄在55至70岁之间、未怀疑患有前列腺癌的男性进行的前瞻性比较研究。只要长达5年的时间里，每年对每个受试者进行DRE、TRUS和PSA检查。根据DRE或TRUS结果的建议进行活检。虽然单独PSA升高通常不是活检的依据，但在某些情况下，由于PSA升高的程度，建议进行活检。诊断由参与的病理学家和病理分析确认。
在诊断时，从临床分期来看，检测到的一小部分癌症已处于晚期。总共只有6例癌症为C1至D1期，其中5例是在首次检查时发现的既往存在的癌症。通过DRE检测到的癌症往往比仅基于TRUS或PSA发现的癌症更晚期。很大一部分患者接受了根治性治疗，其中67.9%接受了根治性前列腺切除术，17.9%接受了放射治疗。在100名被认为患有器官局限性疾病并接受前列腺切除术治疗的男性中，64名实际上被证实患有局限性癌症，分期上调率为36.0%。PSA水平和PSA密度与器官局限性癌症的检测相关，但一些晚期癌症的PSA水平在正常范围内，限制了这些指标在分期方面的实用性。
这种多模式检测努力所发现的癌症代表了一系列病理结果。然而，这些数据表明，对未怀疑患有前列腺癌的男性进行早期检测干预将产生分期分布良好的肿瘤，这些肿瘤可能从治疗中获益。需要进一步的随访评估来确定这些益处是否反映在长期死亡率和生存经验中。
