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反思前列腺癌筛查的利弊权衡
Reconsidering the Trade-offs of Prostate Cancer Screening


Jonathan E. Shoag ... 肿瘤 • 2020.06.18
相关阅读
• 重新审视前列腺癌死亡率——PSA筛查的未来

前列腺特异性抗原(PSA)筛查于20世纪90年代早期广泛实施后,诊断出的前列腺癌迅速增加,同时死亡率在接下来的25年间下降了一半1。随机试验的初步结果和专业学会就筛查发布的反对意见(最近有所缓和)可能是过去10年间人们不再积极接受筛查的原因之一2-4。筛查减少与诊断出的前列腺癌持续减少相关1。虽然这并不一定反映最终发生转移性前列腺癌的患者数量的变化,但有一些证据提示,2010年之前一直在下降的诊断时的转移性前列腺癌发病率目前可能正在上升1,5-8。PSA筛查减少有很多原因,但部分原因似乎是对现有随机试验数据的错误解读,以及在评估利弊时缺乏对随访时间的关注。我们在本文中利用最新数据重新评估了PSA筛查可能产生的远期效应。

关于PSA筛查的主流观点是“有关PSA筛查的两项大型、随机、对照试验表明筛查的益处不明确或无益处”9。这一观点是有问题的。其中一项试验是前列腺癌、肺癌、结直肠癌和卵巢癌(PLCO)筛查试验(Prostate,Lung,Colorectal,and Ovarian [PLCO] Cancer Screening Trial),该试验不能用于评估筛查相对于不筛查的效果,因为对照组中近90%的男性都接受过PSA检测10-13。另外一个被广泛引用的筛查试验是欧洲前列腺癌筛查随机研究(European Randomized Study of Screening for Prostate Cancer,ERSPC),本试验中对照组的筛查率显著低于PLCO试验的对照组14。ERSPC最近一次更新的数据估计,在16年随访中,为了预防1例前列腺癌死亡,需要对570名55~69岁的男性进行筛查15,16。这一获益在定性上类似于支持乳腺癌筛查的建议,即为了在10年时预防1例乳腺癌死亡,需要对1,250名50~59岁女性、476名60~69岁女性、769名70~74岁女性进行筛查17





作者信息

Jonathan E. Shoag, M.D., Yaw A. Nyame, M.D., M.B.A., Roman Gulati, M.S., Ruth Etzioni, Ph.D., and Jim C. Hu, M.D., M.P.H.
From the Department of Urology, Weill Cornell Medicine, New York (J.E.S., J.C.H.); and the Department of Urology, University of Washington (Y.A.N.), and the Division of Public Health Sciences, Fred Hutchinson Cancer Research Center (Y.A.N., R.G., R.E.) — both in Seattle.

 

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