从大样本临床研究看PSA筛查检出前列腺癌的意义

The role of prostate cancer screening:a literature review of the current evidence

前列腺癌是全球性的公共健康挑战。前列腺特异性抗原(PSA)作为基础筛查显著提高了前列腺癌诊断率,但潜在的副作用不容忽视。前列腺癌筛查能否降低死亡率仍有争议,数个大样本临床研究的结论莫衷一是。欧洲前列腺癌筛查随机研究以及瑞典哥德堡研究显示筛查降低死亡率,而美国前列腺、肺、结直肠和卵巢癌筛查研究的结论相反。对前列腺癌筛查的担忧主要包括筛查本身的并发症以及对惰性前列腺癌的过度诊断和治疗。目前总体证据支持进行前列腺癌筛查,但需要采取措施积极改进筛查的策略。

Prostate cancer presents a global public health dilemma. While screening with prostate specific antigen （PSA） has led to more men diagnosed with prostate cancer than in previous years, the potential for negative effects from over-diagnosis and treatment cannot be ignored. The value of PSA screening in reducing disease mortality is controversial and several studies have been conducted to determine the actual benefits. Results from the European Randomized Screening for Prostate Cancer （ERSPC）, the Prostate, Lung, Colorectal, Ovarian （PLCO） Cancer Screening Trial, and Goteborg Swedish trials regarding pros- tate screening are controversial with the ERSPC. Goteborg showed a reduction in prostate cancer mortality while the PLCO tri- al showed no benefit. The arguments against PSA screening include risks associated with screening tests themselves and over-di- agnosis and overtreatment of prostate cancer. The overall evidences in favor of PSA screening and steps needed to be taken to address the issue of screening strategy before a population-based screening programme can be enacted.