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前列腺癌的前列腺特异性抗原基查:美国预防服务工作组的证据报告和系统审查
Joshua J Fenton1,2, Meghan S Weyrich1, Shauna Durbin1
1Center for Healthcare Policy and Research, University of California, Davis, Sacramento.
JAMA
|May 26, 2018
概括
前列腺特异性抗原 (PSA) 查可能会降低前列腺癌死亡率,但会导致错误阳性,活检和过度诊断. 治疗提供不明的生存益处, 但增加性和尿道问题.
科学领域:
- 泌尿外科
- 癌症学
- 预防医学
背景情况:
- 前列腺癌是美国男性癌症死亡的主要原因.
- 基于前列腺特异性抗原 (PSA) 的查和局部癌症治疗的证据需要系统审查.
研究的目的:
- 审查PSA查,局部前列腺癌治疗和风险计算器的证据.
- 为美国预防服务工作组 (USPSTF) 准则提供信息.
主要方法:
- 随机临床试验 (RCT) 和队列研究的系统审查 (2011年7月至2017年7月,并于2018年2月进行监测).
- 包括查,局部癌症治疗与保守管理以及风险计算器验证的研究.
- 两个独立的调查人员进行数据提取和质量评估.
主要成果:
- 在欧洲的一项试验中,PSA查显示前列腺癌死亡率降低 (RR 0. 79),但在美国或英国的试验中没有.
- 在17. 8%的男性中出现了假阳性结果;在0. 5% - 1. 6%的男性中出现了活检并发症.
- 过度诊断率在20. 7%至50. 4%之间;积极治疗没有显著的生存益处,但增加了泌尿和性功能障碍.
结论:
- PSA 查可能会降低前列腺癌的死亡率,但会导致错误阳性,并发症和过度诊断的风险.
- 查发现的癌症的活性治疗对生存有不确定的益处,对生活质量有不良影响.
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