Villers A, Soulié M, Haillot O, Boccon-Gibod L
Clinique Esquirol, Agen, France.
Prog Urol. 1997 Sep;7(4):655-61.
The Oncology Committee of the Association Française d'Urologie has up-dated the knowledge concerning prostatic cancer screening since the 1989 Consensus Conference. The results are published in the form of a series of articles referring to the criteria used as prerequisites for cancer screening programmes. This article reports the data of the literature concerning risk factors, natural history, course without treatment and histological characteristics of the cancer detected. 1) Certain populations have an increased risk due to genetic factors. A family history (first degree relative) is associated with a 2- to 3-fold higher risk of prostatic cancer. This familial aggregation can be used to define a high-risk group constituting a primary target for screening. 2) The natural history of the disease, especially the progression from the asymptomatic stage to the clinical stage and the natural history of the disease at the clinical stage are now sufficiently well known. The concept of latent cancer has not been confirmed as the disease inevitably progresses. Cancers of insignificant volume, less than 0.5 cc (discovered at autopsy) are classically distinguished from cancers of significant volume, greater than 0.5 cc, but asymptomatic (risk of progression with mortality within 15 years), and local and/or metastatic symptomatic cancers. The histological prevalence of prostatic cancer is 43% in a group of men with a mean age of 64 years and increases with age. 92% of histological cancers have a volume less than 0.5 cc. It takes an estimated 12 years (3 doubling times) for a 0.5 cc cancer to reach a volume of 4 cc, the volume beyond which there is a risk of distant metastases. In the absence of curative treatment, a cancer diagnosed at the localized stage before the age of 65 years is associated with a specific survival of less than 30%. The median survival of metastatic prostatic cancer is 2 to 3 years. 3) The disease can be detected at an early stage. Cancers diagnosed by an isolated elevation of PSA in a screening setting have a significant volume in more than 3 out of 4 cases, can be entirely removed by prostatectomy in more than 3 out of 4 cases and have a less advanced pathological stage than cancers diagnosed on the basis of classical criteria.
自1989年共识会议以来，法国泌尿外科学会肿瘤委员会更新了有关前列腺癌筛查的知识。结果以一系列文章的形式发表，这些文章涉及用作癌症筛查计划先决条件的标准。本文报告了有关风险因素、自然史、未经治疗的病程以及所检测癌症的组织学特征的文献数据。1）某些人群由于遗传因素风险增加。家族史（一级亲属）与前列腺癌风险高出2至3倍相关。这种家族聚集可用于定义构成筛查主要目标的高危人群。2）该疾病的自然史，特别是从无症状阶段到临床阶段的进展以及临床阶段疾病的自然史现在已广为人知。潜伏癌的概念尚未得到证实，因为疾病不可避免地会进展。体积小于0.5立方厘米（尸检时发现）的微小癌通常与体积大于0.5立方厘米但无症状（15年内有进展及死亡风险）的显著癌以及局部和/或转移症状性癌区分开来。在平均年龄为64岁的男性群体中，前列腺癌的组织学患病率为43%，且随年龄增长而增加。92%的组织学癌体积小于0.5立方厘米。一个0.5立方厘米的癌症估计需要12年（3个倍增时间）才能达到4立方厘米的体积，超过这个体积就有远处转移的风险。在没有根治性治疗的情况下，65岁之前诊断为局限性阶段的癌症其特异性生存率低于30%。转移性前列腺癌的中位生存期为2至3年。3）该疾病可在早期被检测到。在筛查中通过PSA单独升高诊断出的癌症，超过四分之三的病例体积显著，超过四分之三的病例可通过前列腺切除术完全切除，并且与根据经典标准诊断出的癌症相比，病理分期较晚。
