Benoit R M, Naslund M J
Division of Urology, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA.
Oncology (Williston Park). 1997 Oct;11(10):1533-43; discussion 1543, 1547-8.
The introduction of prostate-specific antigen (PSA) testing for use in the early detection of prostate cancer has led to controversy regarding the appropriateness of prostate cancer screening and any subsequent treatment. Much of this controversy arises from concern over the increased health-care costs that may result from widespread screening. As cost control becomes a dominant concern in today's health-care system, practitioners must decide whether the expense of screening and resulting treatment is worth the expenditure of its limited health-care system, practitioners must decide whether the expense of screening and resulting treatment is worth the expenditure of its limited health-care resources. This review first discusses the effects that widespread PSA screening would have on health-care costs. The benefits that will be realized by the expenditure of these additional health-care dollars are much more difficult to quantify. Decision analysis models have been used to evaluate the effectiveness of prostate cancer screening and treatment and have found little or no benefit. The current review illustrates how assumptions used to construct these models influence their results. The authors present a quantitative analysis of the costs and benefits of prostate cancer screening and treatment. This type of analysis demonstrates that prostate cancer screening and treatment may be a very cost-effective health-care intervention. Although men 50 to 70 years old will potentially benefit the most from PSA screening, this benefit will not be realized until they are in their seventh or eight decade of life. Society must decide if the years of life saved in these men warrants the use of its limited health-care resources. This decision will be easier when randomized, controlled trials are available to quantify the costs and benefits of PSA screening.
引入前列腺特异性抗原（PSA）检测用于早期发现前列腺癌引发了关于前列腺癌筛查及后续治疗是否恰当的争议。这场争议很大程度上源于对广泛筛查可能导致医疗保健成本增加的担忧。随着成本控制成为当今医疗保健系统的主要关注点，从业者必须决定筛查及后续治疗的费用是否值得耗费其有限的医疗保健资源。本综述首先讨论广泛的PSA筛查对医疗保健成本的影响。花费这些额外的医疗保健资金所能实现的益处则更难量化。决策分析模型已被用于评估前列腺癌筛查和治疗的有效性，但发现益处甚微或没有益处。当前的综述阐述了用于构建这些模型的假设如何影响其结果。作者对前列腺癌筛查和治疗的成本与效益进行了定量分析。这类分析表明，前列腺癌筛查和治疗可能是一种非常具有成本效益的医疗保健干预措施。虽然50至70岁的男性可能从PSA筛查中获益最大，但这种益处要到他们七十多岁或八十多岁时才会显现。社会必须决定在这些男性身上节省的生命年限是否值得动用其有限的医疗保健资源。当有随机对照试验可用于量化PSA筛查的成本和效益时，这个决定会更容易做出。
