Mettlin C J, Murphy G P, Babaian R J, Chesley A, Kane R A, Littrup P J, Mostofi F K, Ray P S, Somers W J, Toi A
Roswell Park Cancer Institute, Buffalo, New York 14263, USA.
Cancer. 1997 Nov 1;80(9):1814-7. doi: 10.1002/(sici)1097-0142(19971101)80:9<1814::aid-cncr20>3.0.co;2-7.
The American Cancer Society National Prostate Cancer Detection Project (ACS-NPCDP) was established in 1987. The experience of the ACS-NPCDP demonstrates the yield and impact of periodic examinations for the early detection of prostate cancer.
A cohort of 2999 well men ages 55-70 years was tested annually at 10 clinical centers by prostate specific antigen (PSA), transrectal ultrasound (TRUS), and digital rectal examination (DRE). Biopsies were performed on men with suspicious findings. Pathologic findings were reviewed. The initial study outcomes were the detection yield of multimodality testing and the comparative sensitivity and specificity of the different tests employed. Longer term outcomes included patient quality of life and survival.
The cancer detection rate declined significantly across the years of intervention. DRE had lower sensitivity than TRUS or PSA, particularly in later years of follow-up. The specificity of TRUS was lower than that of DRE. Fewer than 9% of the cancers detected in this study were clinically advanced at the time of diagnosis. Ninety-four percent of patients in whom cancer was detected are alive after an average follow-up of 54 months. In one case, death occurred after surgery. Two deaths were attributed to prostate cancer, and eleven other deaths were unrelated to prostate cancer or its treatment.
Results of the ACS-NPCDP indicate that a combined-modality approach to prostate cancer detection yields high levels of early detection with infrequent adverse outcomes. Continued follow-up is required to evaluate long term morbidity and mortality.
美国癌症协会国家前列腺癌检测项目（ACS-NPCDP）于1987年设立。ACS-NPCDP的经验证明了定期检查对前列腺癌早期检测的成效和影响。
在10个临床中心，对2999名年龄在55至70岁的健康男性每年进行前列腺特异性抗原（PSA）、经直肠超声（TRUS）和直肠指检（DRE）检测。对有可疑结果的男性进行活检，并对病理结果进行审查。初始研究结果包括多模式检测的检出率以及所采用不同检测方法的比较敏感性和特异性。长期结果包括患者的生活质量和生存率。
在干预的几年中，癌症检出率显著下降。直肠指检的敏感性低于经直肠超声或前列腺特异性抗原，尤其是在随访后期。经直肠超声的特异性低于直肠指检。本研究中检测到的癌症在诊断时临床晚期的不到9%。在平均随访54个月后，94%检测出癌症的患者仍然存活。有1例患者在手术后死亡。2例死亡归因于前列腺癌，另有11例死亡与前列腺癌或其治疗无关。
ACS-NPCDP的结果表明，采用联合模式方法进行前列腺癌检测可实现高水平的早期检测，且不良后果罕见。需要持续随访以评估长期发病率和死亡率。
