根据澳大利亚指南进行前列腺特异性抗原测试的好处和危害
Michael Caruana1, Roman Gulati2, Ruth Etzioni2
1The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, New South Wales, Australia.
International journal of cancer
|October 11, 2023
概括
对澳大利亚50-69岁男性进行定期前列腺特异性抗原 (PSA) 检测可以减少前列腺癌死亡率,但会增加过度诊断. 为了避免每一次前列腺癌死亡,有两名男性被过度诊断,这突显了查决策中的关键权衡.
科学领域:
- 在瘤学瘤学.
- 公共卫生 公共卫生
- 卫生经济学 卫生经济学
背景情况:
- 澳大利亚的指导方针建议每两年对50-69岁的平均风险男性进行前列腺特异性抗原 (PSA) 测试.
- 这种定期的PSA测试策略的益处和危害需要定量估计,以告知临床实践和患者决策.
- 了解减少前列腺癌死亡率和过度诊断风险之间的平衡对于有效的查计划至关重要.
研究的目的:
- 估计遵守澳大利亚指导方针对平均风险男性定期进行PSA检测的好处和危害.
- 量化两年一次的PSA检测对前列腺癌死亡率和特定年龄组的过度诊断率的影响.
- 为考虑PSA查的澳大利亚男性提供数据,以支持知情决策.
主要方法:
- 开发 Policy1-Prostate,一个离散事件微模拟平台,模拟前列腺癌的自然史,生存率和澳大利亚的PSA测试模式.
- 模型校准使用前PSA时代前列腺癌发病率和死亡率数据.
- 对澳大利亚发病率/死亡率趋势 (1985-2011) 和国际临床试验数据的模型验证.
主要成果:
- 在接受PSA测试的1000名男性中 (年龄在50-69岁之间),36人将死于前列腺癌,而在没有测试的组中,50人将死于前列腺癌.
- 在每1000名男性中,PSA检测导致126例诊断,而没有检测则为94例;32%的癌症被过度诊断.
- 过度诊断病例与预防前列腺癌死亡的比例约为2:1.
结论:
- 澳大利亚50-69岁男性每两年进行PSA检测可以降低前列腺癌的死亡率,但会显著增加过度诊断的风险.
- 这些发现突出了一个权衡,即每救一个前列腺癌生命,就会有两个男人被过度诊断.
- 这些定量估计可以帮助卫生专业人员和患者做出有关PSA查的明智决策.
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