Collins M M, Barry M J
General Medicine Division, Medical Services, Massachusetts General Hospital, Boston 02114, USA.
JAMA. 1996 Dec 25;276(24):1976-9.
The current debate regarding early detection and aggressive treatment of prostate cancer is fueled by the absence of controlled studies defining the risks and benefits of prostate cancer screening, and by the lack of adequately powered trials demonstrating the benefit of curative treatment for early-stage prostate cancer. Pending the results of clinical trials in 10 to 15 years, advocates of early detection of prostate cancer with digital rectal examination and prostate-specific antigen have compared prostate cancer screening with the effective strategy of breast cancer screening, implying that prostate cancer screening should similarly reduce cancer mortality. They have also cited the high burden of disease, the acceptable operating characteristics of digital rectal examination and prostate-specific antigen, a stage shift among cases detected by screening, and the theoretical curability of early-stage disease as sufficient reasons to proceed with screening. These arguments, however, are reminiscent of earlier arguments in favor of lung cancer screening with chest x-ray examination and sputum cytology, a practice ultimately proven ineffective in clinical trials. We reviewed published articles on lung and prostate cancer screening and identified many parallels. While prostate cancer screening may one day prove effective, analogies between the current prostate cancer screening controversy and the older lung cancer screening debate should inject some caution regarding widespread dissemination of prostate cancer screening without experimental evidence that such screening does more good than harm.
目前关于前列腺癌早期检测和积极治疗的争论愈演愈烈，原因在于缺乏确定前列腺癌筛查风险和益处的对照研究，以及缺乏足够规模的试验来证明早期前列腺癌根治性治疗的益处。在未来10到15年临床试验结果出来之前，主张通过直肠指检和前列腺特异性抗原进行前列腺癌早期检测的人，将前列腺癌筛查与有效的乳腺癌筛查策略相比较，暗示前列腺癌筛查同样应能降低癌症死亡率。他们还列举了疾病负担沉重、直肠指检和前列腺特异性抗原可接受的操作特性、筛查发现病例的分期变化以及早期疾病的理论可治愈性等，作为进行筛查的充分理由。然而，这些论点让人想起早期支持通过胸部X线检查和痰细胞学进行肺癌筛查的论点，而这一做法最终在临床试验中被证明是无效的。我们查阅了已发表的关于肺癌和前列腺癌筛查的文章，并发现了许多相似之处。虽然前列腺癌筛查有朝一日可能被证明是有效的，但当前前列腺癌筛查争议与过去肺癌筛查争论之间的类比，应促使人们在没有实验证据表明这种筛查利大于弊的情况下，对广泛开展前列腺癌筛查保持谨慎。
