Roberts R O, Bergstralh E J, Katusic S K, Lieber M M, Jacobsen S J
Department of Health Sciences Research, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA.
J Urol. 1999 Feb;161(2):529-33.
We describe trends in prostate cancer mortality from 1980 to 1997, before and after the introduction of serum prostate specific antigen (PSA) testing to the community medical practice, and provide an update on trends in incidence since 1992.
All men with a diagnosis of prostate cancer who died between 1980 and 1997 were identified and parts 1 and 2 of the death certificates were reviewed for a diagnosis of prostate cancer. In addition, all men with biopsy proved prostate cancer diagnosed between 1983 and 1995 were identified. The complete medical records of incident cases of prostate cancer were reviewed for signs and symptoms at diagnosis and for the first treatment received.
Age adjusted, community mortality rates from prostate cancer increased from 25.8/100,000 men in 1980 to 1984 to a peak of 34/100,000 in 1989 to 1992, and have since declined to 19.4/100,000 in 1993 to 1997 (22% decline in mortality, 95% confidence interval 49% decline to 17% increase). The overall age adjusted incidence rates which peaked at 209/100,000 person-years in 1992 as previously reported declined to 108/100,000 in 1993 and 132/100,000 in 1995. A similar pattern was observed for organ confined cancers. However, incidence rates for regional or distant disease were suggestive of a continuing downward trend from 1989 to 1992 compared to 1993 to 1995 (12% decline per year, p = 0.07).
These data demonstrate that despite the increase in prostate cancer mortality rates in the mid to late 1980s, mortality rates in 1993 to 1997 are lower than in the years before serum PSA testing. While chance cannot be ruled out, the data suggest that increased screening for prostate cancer, particularly through PSA testing, may have led to declines in mortality from prostate cancer.
我们描述了1980年至1997年社区医疗实践引入血清前列腺特异性抗原（PSA）检测前后前列腺癌死亡率的趋势，并提供了自1992年以来发病率趋势的最新情况。
确定了1980年至1997年间所有诊断为前列腺癌并死亡的男性，并审查了死亡证明的第1部分和第2部分以诊断前列腺癌。此外，还确定了1983年至1995年间所有经活检证实为前列腺癌的男性。审查了前列腺癌发病病例的完整医疗记录，以了解诊断时的体征和症状以及接受的首次治疗。
年龄调整后的社区前列腺癌死亡率从1980年至1984年的25.8/10万男性增加到1989年至1992年的峰值34/10万，此后在1993年至1997年降至19.4/10万（死亡率下降22%，95%置信区间为下降49%至上升17%）。如先前报道，总体年龄调整发病率在1992年达到峰值209/10万人年，1993年降至108/10万，1995年降至132/10万。器官局限性癌症也观察到类似模式。然而，与1993年至1995年相比，1989年至1992年区域或远处疾病的发病率呈持续下降趋势（每年下降12%，p = 0.07）。
这些数据表明，尽管20世纪80年代中后期前列腺癌死亡率有所上升，但1993年至1997年的死亡率低于血清PSA检测之前的年份。虽然不能排除偶然性，但数据表明前列腺癌筛查的增加，特别是通过PSA检测，可能导致了前列腺癌死亡率的下降。
