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基于低强度PSA查干预对前列腺癌死亡率的影响:CAP随机临床试验
Richard M Martin1,2, Jenny L Donovan1,3, Emma L Turner1
1Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England.
JAMA
|March 7, 2018
概括
在英国的一项大型试验中,单次前列腺特异性抗原 (PSA) 查并没有降低前列腺癌死亡率. 然而,它增加了低风险癌症的检测,这表明它可能不适合全民查.
科学领域:
- 尿道病学
- 癌症学
- 公共卫生
背景情况:
- 由于前列腺癌的潜在益处与过度检测和过度治疗等危害,前列腺癌查受到争议.
- 前列腺癌查试验 (CAP) 的目的是澄清前列腺特异性抗原 (PSA) 测试的影响.
研究的目的:
- 评估单次PSA查干预对前列腺癌特异性死亡率的影响.
- 评估二次结果,包括癌症阶段,等级和全因死亡率.
主要方法:
- 这是一项集群随机试验,涉及英国50至69岁的419,582名男性.
- 干预组接受了一次PSA测试邀请;对照组接受标准护理.
- 随访时间中位数为10年,主要结论是前列腺癌特异性死亡率.
主要成果:
- 干预组和对照组之间的前列腺癌特异性死亡率没有显著差异 (每1000人/ 年0. 30对0. 31).
- 在干预组中,前列腺癌的诊断增加 (4. 3% 与 3. 6% 相比) 和低度瘤的检测.
- 两组之间无明显的死亡率差异.
结论:
- 一次PSA查干预并没有降低前列腺癌死亡率.
- 这种干预导致低风险前列腺癌的检测增加,引发了过度诊断的担忧.
- 结果不支持单个PSA测试用于基于人群的前列腺癌查.
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