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PSA检测真的利大于弊吗?

来源:生物谷 2014-08-12 09:08

2014年8月11日讯 /生物谷BIOON/--有关PSA检测男性前列腺癌的价值已经争论许久,一项针对162,000名男性进行的研究,可能仍然无法解决这一问题。发表在The Lancet杂志上的一项新研究,认为广泛使用的前列腺特异性抗原(PSA)血液检查,虽然能减少该疾病导致的死亡约五分之一,然而,由于挥之不去的有关PSA筛检好处是否大于风险的疑虑,该研究报告的作者仍然建议对这个日常使用的检测方法进行评估。

PSA筛检确实大幅减少前列腺癌的死亡率,研究的主要作者Fritz Schroder说:不过大约40%的情况下,会发生过度诊断,导致高风险的过度治疗和常见副作用,如尿失禁和阳痿。

在前列腺癌的背景下,“过度诊断”是指有些人可能会从他们的PSA测试中确认前列腺癌的诊断,但其实肿瘤可能是生长缓慢,可能不会对他们的健康构成重大威胁。然而,积极的测试结果仍可能会导致许多患者选择会带来副作用的治疗方法。

这项新的研究包括了来自八个欧洲国家的,年龄在50至74之间的162,000多人。这些人随机分为每两年或四年选择PSA筛检,或无PSA筛检组别。相较于没有筛选的男性,九年后,男人在筛查组中的死亡率降低15%,经过11年后死亡率降低22%,而13年后降低21%。

Schroder研究小组指出,在研究中,不是所有的人都会选择筛检来进行前列腺癌检测。13年后,那些真正筛选的男性比那些没有选择筛选的男性,死于前列腺癌的可能性减少27%。该研究还发现13年后,781人确实需要被要求进行筛选,以防止一个前列腺癌死亡。

但根据研究结果显示,Schroder认为,以人口为基础的筛查的时候还没有到。迫切需要进一步研究如何最好避免不必要的活检,以减少误诊及过度治疗,帮助只有少数真正需要筛查的病人。(生物谷Bioon.com)

Screening and prostate cancer mortality: results of the European Randomised Study of Screening for Prostate Cancer (ERSPC) at 13 years of follow-up

Prof Fritz H Schrder, et al.

Background
The European Randomised study of Screening for Prostate Cancer (ERSPC) has shown significant reductions in prostate cancer mortality after 9 years and 11 years of follow-up, but screening is controversial because of adverse events such as overdiagnosis. We provide updated results of mortality from prostate cancer with follow-up to 2010, with analyses truncated at 9, 11, and 13 years.
Methods
ERSPC is a multicentre, randomised trial with a predefined centralised database, analysis plan, and core age group (55—69 years), which assesses prostate-specific antigen (PSA) testing in eight European countries. Eligible men aged 50—74 years were identified from population registries and randomly assigned by computer generated random numbers to screening or no intervention (control). Investigators were masked to group allocation. The primary outcome was prostate cancer mortality in the core age group. Analysis was by intention to treat. We did a secondary analysis that corrected for selection bias due to non-participation. Only incidence and no mortality data at 9 years’ follow-up are reported for the French centres. This study is registered with Current Controlled Trials, number ISRCTN49127736.
Findings
With data truncated at 13 years of follow-up, 7408 prostate cancer cases were diagnosed in the intervention group and 6107 cases in the control group. The rate ratio of prostate cancer incidence between the intervention and control groups was 1·91 (95% CI 1·83—1·99) after 9 years (1·64 [1·58—1·69] including France), 1·66 (1·60—1·73) after 11 years, and 1·57 (1·51—1·62) after 13 years. The rate ratio of prostate cancer mortality was 0·85 (0·70—1·03) after 9 years, 0·78 (0·66—0·91) after 11 years, and 0·79 (0·69—0·91) at 13 years. The absolute risk reduction of death from prostate cancer at 13 years was 0·11 per 1000 person-years or 1·28 per 1000 men randomised, which is equivalent to one prostate cancer death averted per 781 (95% CI 490—1929) men invited for screening or one per 27 (17—66) additional prostate cancer detected. After adjustment for non-participation, the rate ratio of prostate cancer mortality in men screened was 0·73 (95% CI 0·61—0·88).
Interpretation
In this update the ERSPC confirms a substantial reduction in prostate cancer mortality attributable to testing of PSA, with a substantially increased absolute effect at 13 years compared with findings after 9 and 11 years. Despite our findings, further quantification of harms and their reduction are still considered a prerequisite for the introduction of populated-based screening.

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