Richie Jerome P, Catalona William J, Ahmann Frederick R, Hudson M'Liss A, Scardino Peter T, Flanigan Robert C, deKernion Jean B, Ratliff Timothy L, Kavoussi Louis R, Dalkin Bruce L, Waters W Bedford, MacFarlane Michael T, Southwick Paula C
Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Urology. 1993 Oct;42(4):365-74. doi: 10.1016/0090-4295(93)90359-i.
This study was designed to determine the effects of age by decade on the efficacy of digital rectal examination (DRE) and serum prostate-specific antigen (PSA) for early detection of prostate cancer in men aged fifty and over. A prospective multicenter clinical trial was conducted at six university centers. All 6,630 male volunteers underwent a serum PSA (Hybritech, Tandem) determination and DRE. Quadrant biopsies of the prostate were performed if PSA was > 4 ng/mL or DRE suspicious. A total of 1,167 biopsies were performed, and 264 cancers were detected. The cancer detection rate increased from 3 percent in men aged fifty to fifty-nine to 14 percent in men eighty years or older (p < 0.0001). PSA detected significantly more of the total cancers than DRE at all age ranges (p < 0.05). The positive predictive values (PPV) for PSA were 32 percent (50-59 years), 30 percent (60-69 years), 34 percent (70-79 years), and 38 percent (80+ years). The corresponding PPVs for DRE were 17 percent, 21 percent, 25 percent, and 38 percent. Eighteen percent of the cancers were detected solely by DRE, whereas 45 percent of cancers were detected solely by PSA. Thus, the use of both tests in combination provided the highest rate of detection in all age groups. One hundred-sixty patients underwent radical prostatectomy and pathologic staging. Cancer was organ-confined in 74 percent (25/34) of men aged fifty to fifty-nine, 76 percent (65/86) of men aged sixty to sixty-nine, and 60 percent (24/40) of men aged seventy or over (chi 2, < 70 vs. > or = 70, p < 0.05). Early detection programs yield a lower, yet still substantial, cancer detection rate in younger men, and there is a greater likelihood for detection of organ-confined disease in this age range. Younger men have the longest projected life expectancy and, therefore, the most to gain from early prostate cancer detection.
本研究旨在确定每十岁年龄组对直肠指检（DRE）和血清前列腺特异性抗原（PSA）在50岁及以上男性早期前列腺癌检测中效能的影响。在六个大学中心进行了一项前瞻性多中心临床试验。所有6630名男性志愿者均接受了血清PSA（Hybritech，Tandem）检测和直肠指检。如果PSA>4 ng/mL或直肠指检可疑，则进行前列腺四象限活检。共进行了1167次活检，检测出264例癌症。癌症检出率从50至59岁男性的3%增至80岁及以上男性的14%（p<0.0001）。在所有年龄范围内，PSA检测出的癌症总数显著多于直肠指检（p<0.05）。PSA的阳性预测值（PPV）在50 - 59岁为32%，60 - 69岁为30%，70 - 79岁为34%，80岁及以上为38%。直肠指检的相应PPV分别为17%、21%、25%和38%。18%的癌症仅通过直肠指检检出，而45%的癌症仅通过PSA检出。因此，两种检测方法联合使用在所有年龄组中的检出率最高。160例患者接受了前列腺根治术和病理分期。50至59岁男性中74%（25/34）的癌症局限于器官内，60至69岁男性中76%（65/86），70岁及以上男性中60%（24/40）（卡方检验，<70岁与≥70岁相比，p<0.05）。早期检测项目在年轻男性中的癌症检出率较低，但仍相当可观，且在该年龄范围内检测到局限于器官内疾病的可能性更大。年轻男性预期寿命最长，因此从早期前列腺癌检测中获益最大。
