背景:考虑到前列腺癌(PCa)的漫长自然史,欧洲随机PCa筛查研究(ERSPC)的长期结果至关重要.
目的:提供基于前列腺特异性抗原(PSA)的筛查对PCa特异性死亡率(PCSM)的影响的最新信息,转移性疾病,以及ERSPC荷兰分支的过度诊断。
方法:在1993年至2000年之间,共有42376名男性,55-74岁,被随机分配到筛查或对照组。主要分析年龄在55-69岁的男性(n=34831)。筛查组的男性接受基于PSA的筛查,间隔为4年。
方法:使用泊松回归的意图筛选分析来计算PCSM和转移性PCa的比率(RR)。
结论:经过21年的中位随访,PCSM的RR为0.73(95%置信区间[CI]:0.61~0.88),有利于筛查.需要邀请(NNI)和诊断(NND)以防止一例PCa死亡的男性人数分别为246和14。对于转移性PCa,RR为0.67(95%CI:0.58-0.78),有利于筛查.预防一次转移的NNI和NND分别为121和7。在随机化时年龄≥70岁的男性中,PCSM没有统计学差异(RR为1.18[95%CI:0.87-1.62])。在筛选臂中,在仅接受一次筛查的男性和筛选年龄超过74岁的选定男性组中,PCSM和转移性疾病的发生率更高.
结论:当前的分析表明,经过21年的随访,绝对转移和死亡率降低都继续增加,导致比以前更有利的利害比。这些数据不支持在70-74岁时开始筛查,并且表明重复筛查是必不可少的。
结果:基于前列腺特异性抗原的前列腺癌筛查可减少转移和死亡率。更长时间的随访显示,预防一人死亡所需的邀请和诊断更少,对过度诊断问题的积极说明。
Considering the long natural history of prostate cancer (PCa), long-term results of the European Randomised Study of Screening for PCa (ERSPC) are crucial.
To provide an update on the effect of prostate-specific antigen (PSA)-based screening on PCa-specific mortality (PCSM), metastatic disease, and overdiagnosis in the Dutch arm of the ERSPC.
Between 1993 and 2000, a total of 42376 men, aged 55-74 yr, were randomised to a screening or a control arm. The main analysis was performed with men aged 55-69 yr (n = 34831). Men in the screening arm were offered PSA-based screening with an interval of 4 yr.
Intention-to-screen analyses with Poisson regression were used to calculate rate ratios (RRs) of PCSM and metastatic PCa.
After a median follow-up of 21 yr, the RR of PCSM was 0.73 (95% confidence interval [CI]: 0.61-0.88) favouring screening. The numbers of men needed to invite (NNI) and needed to diagnose (NND) to prevent one PCa death were 246 and 14, respectively. For metastatic PCa, the RR was 0.67 (95% CI: 0.58-0.78) favouring screening. The NNI and NND to prevent one metastasis were 121 and 7, respectively. No statistical difference in PCSM (RR of 1.18 [95% CI: 0.87-1.62]) was observed in men aged ≥70 yr at the time of randomisation. In the screening arm, higher rates of PCSM and metastatic disease were observed in men who were screened only once and in a selected group of men above the screening age cut-off of 74 yr.
The current analysis illustrates that with a follow-up of 21 yr, both absolute metastasis and mortality reduction continue to increase, resulting in a more favourable harm-benefit ratio than demonstrated previously. These data do not support starting screening at the age of 70-74 yr and show that repeated screening is essential.
Prostate-specific antigen-based prostate cancer screening reduces metastasis and mortality. Longer follow-up shows fewer invitations and diagnoses needed to prevent one death, a positive note towards the issue of overdiagnosis.