Mettlin C, Murphy G P, Babaian R J, Chesley A, Kane R A, Littrup P J, Mostofi F K, Ray P S, Shanberg A M, Toi A
Roswell Park Cancer Institute, Buffalo, NY 14263, USA.
Cancer. 1996 Jan 1;77(1):150-9. doi: 10.1002/(SICI)1097-0142(19960101)77:1<150::AID-CNCR25>3.0.CO;2-3.
The American Cancer Society-National Prostate Cancer Detection Project (ACS-NPCDP) is a multidisciplinary evaluation of early prostate cancer detection interventions. This report summarizes the experience of the investigators to date and describes the overall and relative performance of the different detection modalities studied in this project.
Two thousand nine hundred ninety-nine men aged 55 to 70 years at entry who were not already under evaluation for prostate cancer were recruited to participate in up to 5 annual examinations by prostate specific antigen (PSA), digital rectal examination (DRE), and transrectal ultrasound (TRUS). In the course of 5 years of intervention, ACS-NPCDP investigators have completed 9937 examinations, recommended 1215 biopsies, and detected 203 cancers.
Loss to cohort follow-up was greatest in the first year. Overall, TRUS led to twice the number of recommendations for biopsy compared with DRE (8.9% versus 4.4%). Elevated PSA was observed in 13.0% of 9535 measurements performed. The overall cancer detection rate declined significantly during the five years of intervention. Detection was significantly associated with age and symptom status at entry. DRE had lower sensitivity compared with TRUS or PSA, particularly in later years of follow-up. The specificity of TRUS was lower than that for DRE. PSA was elevated in 69.2% of examinations that led to cancer detection, compared with only 10.9% when cancer was not found. PSA level, PSA density, and PSA change were all related to the presence of cancer. Less than 6% of the cancers detected in this study were clinically advanced at the time of diagnosis.
These data quantify the yield of early cancer detection that may be expected when PSA, DRE, and TRUS are used in populations comparable to the men participating in the ACS-NPCDP. Continued follow-up and further research is needed to assess whether men receiving early prostate cancer interventions benefit as a result.
美国癌症协会-国家前列腺癌检测项目（ACS-NPCDP）是一项针对早期前列腺癌检测干预措施的多学科评估。本报告总结了迄今为止研究人员的经验，并描述了该项目中所研究的不同检测方式的总体及相对性能。
招募了2999名年龄在55至70岁之间、未接受过前列腺癌评估的男性，对其进行多达5次的年度检查，检查项目包括前列腺特异性抗原（PSA）检测、直肠指检（DRE）和经直肠超声检查（TRUS）。在为期5年的干预过程中，ACS-NPCDP的研究人员共完成了9937次检查，建议进行1215次活检，并检测出203例癌症。
队列随访失访情况在第一年最为严重。总体而言，与直肠指检相比，经直肠超声检查导致的活检建议数量是其两倍（8.9%对4.4%）。在进行的9535次测量中，13.0%观察到PSA升高。在五年的干预期间，总体癌症检测率显著下降。检测结果与入组时的年龄和症状状态显著相关。与经直肠超声检查或PSA相比，直肠指检的敏感性较低，尤其是在随访后期。经直肠超声检查的特异性低于直肠指检。在检测出癌症的检查中，69.2%的检查PSA升高，而未发现癌症时这一比例仅为10.9%。PSA水平、PSA密度和PSA变化均与癌症的存在有关。本研究中检测出的癌症在诊断时临床晚期的比例不到6%。
这些数据量化了在与参与ACS-NPCDP的男性类似的人群中使用PSA、直肠指检和经直肠超声检查时可能预期的早期癌症检测率。需要持续随访和进一步研究以评估接受早期前列腺癌干预的男性是否因此受益。
