用前列腺特异性抗原测试进行前列腺癌查:对当前证据的审查
Julia H Hayes1, Michael J Barry2
1Dana-Farber Cancer Institute and Institute of Technology Assessment, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
JAMA
|March 20, 2014
概括
前列腺特异性抗原 (PSA) 对前列腺癌的查显示出混合的结果,一些研究表明没有死亡率的好处. 建议55-69岁的男性与临床医生讨论优缺点.
科学领域:
- 泌尿器科 泌尿器科 泌尿器科 泌尿器科
- 在瘤学瘤学.
- 预防医学 预防医学
背景情况:
- 使用前列腺特异抗原 (PSA) 测试进行前列腺癌查是持续辩论的主题.
- 来自随机试验和建模研究的证据对于理解利益与危害之间的平衡至关重要.
研究的目的:
- 审查随机试验和建模研究中关于PSA查与不查对前列腺癌死亡率的影响的证据.
- 提出一种方法来平衡PSA查的潜在益处和危害.
主要方法:
- 随机对照试验 (前列腺,肺,结肠直肠和卵巢 (PLCO) 和前列腺癌查欧洲随机研究 (ERSPC)) 和相关建模研究的系统审查.
- 从2010年1月到2013年4月,在MEDLINE,EMBASE和科克兰对照试验注册表中进行的搜索.
- 使用美国心脏协会基于证据的评分系统来评价证据水平.
主要成果:
- PLCO试验显示癌症发病率增加,但PSA查对死亡率没有好处.
- ERSPC试验表明癌症发病率增加,但前列腺癌特定死亡率减少,其中37名男性需要诊断一例死亡.
- 危害包括错误的阳性和活检/治疗的并发症;建模表明,诊断和预防死亡的比例可能会随着更长的随访而改善.
结论:
- 对于年龄在55-69岁的平均风险男性来说,临床讨论PSA查的利弊是最受欢迎的.
- 应保留PSA检测给那些明确喜欢查的男性.
- 缓解策略包括两年一次的查,更高的PSA活检门,以及新诊断的前列腺癌的保守治疗.
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