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前立腺がんの前立腺特異抗原ベースのスクリーニング:米国予防サービスタスクフォースのための証拠報告と体系的レビュー
Joshua J Fenton1,2, Meghan S Weyrich1, Shauna Durbin1
1Center for Healthcare Policy and Research, University of California, Davis, Sacramento.
JAMA
|May 26, 2018
まとめ
前立腺特異抗原 (PSA) 検診は前立腺がんによる死亡率を低下させるかもしれないが,偽陽性,生体検診,過剰診断につながる. 治療の効果は不明ですが 性的および尿道の問題が増加します
科学分野:
- 泌尿器科
- 腫瘍学
- 予防 医学
背景:
- 前立腺がんは アメリカ人の癌による死亡の主な原因です
- 前立腺特異抗原 (PSA) ベースのスクリーニングと局所的ながん治療に関する証拠は,体系的なレビューが必要です.
研究 の 目的:
- PSAスクリーニング,局所性前立腺がん治療,リスク計算器に関する証拠をレビューする.
- 予防サービスタスクフォース (USPSTF) のガイドラインを報告する.
主な方法:
- ランダム化臨床試験 (RCT) とコホート研究 (2017年7月 - 2018年2月の監視) の系統的レビュー.
- スクリーニング,局所的ながん治療と保守的な管理,リスク計算器の検証に関する研究が含まれています.
- 2人の独立した調査員によるデータ抽出と品質評価
主要な成果:
- PSAスクリーニングは1つのヨーロッパ試験 (RR 0. 79) で前立腺がんの死亡率の減少を示したが,米国または英国の試験ではそうではなかった.
- 偽陽性結果はスクリーニングされた男性の17. 8%で発生し,生検の合併症は0. 5%から1. 6%で発生した.
- 過剰診断は20. 7%から50. 4%の範囲で,活発な治療は活発なモニタリングに比べて生存の有意な利点を示さなかったが,尿路および性機能不全が増加した.
結論:
- PSAスクリーニングは前立腺がんの死亡率を低下させるかもしれないが,偽陽性,合併症,過剰診断のリスクを伴う.
- スクリーンで検出されたがんに対する積極的な治療は,生存に不確実な利点と生活の質に悪影響を及ぼします.
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