Cantor S B, Spann S J, Volk R J, Cardenas M P, Warren M M
Department of Family Medicine, University of Texas Medical Branch at Galveston, USA.
J Fam Pract. 1995 Jul;41(1):33-41.
The issue of whether to screen men for prostate cancer is controversial. No randomized clinical trials have been completed to confirm the efficacy of screening for prostate cancer. We created a mathematical model of the clinical risks and benefits of screening for prostate cancer.
A Markov decision-analytic model evaluated the outcomes of annually screening asymptomatic men for prostate cancer beginning at age 50 years. The screening and testing algorithm included the digital rectal examination, transrectal ultrasound, and prostate-specific antigen test. A sample of 10 male patients with no history of prostate disease were interviewed to assess their utilities (preferences) regarding the various adverse outcomes of prostate cancer treatment.
The model indicated that no screening was preferred to screening when patients' utilities were considered (24.14 vs 23.47 quality-adjusted life years expected). The optimal decision was sensitive to the utilities of impotence and urethral stricture, the most common adverse outcomes for patients under the age of 65 years. When adverse outcomes of treatment were ignored, screening was favored (24.86 vs 24.22 years of life expectancy.
When quality-of-life preferences of men are considered, the annual screening of asymptomatic patients for prostate cancer is not recommended.
是否对男性进行前列腺癌筛查存在争议。尚未完成随机临床试验来证实前列腺癌筛查的有效性。我们构建了一个关于前列腺癌筛查临床风险与益处的数学模型。
一个马尔可夫决策分析模型评估了从50岁开始每年对无症状男性进行前列腺癌筛查的结果。筛查和检测算法包括直肠指检、经直肠超声检查和前列腺特异性抗原检测。对10名无前列腺疾病病史的男性患者进行了访谈，以评估他们对前列腺癌治疗各种不良后果的效用（偏好）。
该模型表明，考虑患者的效用时，不进行筛查比进行筛查更可取（预期质量调整生命年分别为24.14和23.47）。最佳决策对阳痿和尿道狭窄的效用敏感，这是65岁以下患者最常见的不良后果。当忽略治疗的不良后果时，倾向于进行筛查（预期寿命分别为24.86和24.22年）。
考虑男性的生活质量偏好时，不建议每年对无症状患者进行前列腺癌筛查。
