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Four Flawed Arguments Against Prostate-specific Antigen Screening (and 1 Good One)

机译：反对前列腺特异性抗原筛查的四项有争议的论点（和一项好论点）

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Critics of prostate cancer screening have advanced several arguments as to why prostate-specific antigen (PSA) testing should be dramatically curtailed. In this personal reflection, I review 5 of these arguments, 4 of which are invalid. It is not true that the major randomized trial supporting prostate cancer screening, the European Randomized Study of Screening for Prostate Cancer, is flawed. Similarly, it is untrue that effects on prostate cancer mortality are only small, or that there are no effects at all on overall mortality. The fourth invalid argument is that PSA is a poor test and that it is impossible to tell whether screen-detected cancers are aggressive or indolent. But a fifth argument is indeed valid. PSA screening as it is currently practiced may not do more good than harm because of a high prevalence of screening of older men, gross overtreatment of low-risk disease, inadequate treatment of high-risk disease, and excessive rates of treatment at low-volume centers. The question for the urology community is whether it can be more restrictive about screening, biopsy, and treatment and more readily refer patients to higher volume institutions. Ultimately, the way to win the debate about PSA screening is not only to bring good data to bear but also to change practice so as to ensure that PSA screening does more good than harm. (C) 2015 Elsevier Inc.
机译：前列腺癌筛查的批评者提出了一些关于为何应大幅减少前列腺特异性抗原（PSA）检测的争论。在我个人的反思中，我回顾了其中的5个论点，其中4个是无效的。支持前列腺癌筛查的主要随机试验（欧洲前列腺癌筛查随机研究）存在缺陷是不正确的。同样，对前列腺癌死亡率的影响很小或对整体死亡率完全没有影响是不正确的。第四个无效论点是，PSA测试效果不佳，无法确定筛查出的癌症是侵袭性的还是惰性的。但是第五个论点确实是有效的。目前正在实施的PSA筛查可能弊大于利，原因是筛查男性的患病率较高，对低危疾病的过度治疗，对高危疾病的治疗不足以及小剂量治疗的过度发生中心。泌尿外科界的问题是，它在筛查，活检和治疗方面是否可能更具限制性，是否更容易将患者转介至更高容量的机构。最终，赢得关于PSA筛查的辩论的方法不仅是承载良好的数据，而且是改变惯例，以确保PSA筛查的益处大于危害。 （C）2015爱思唯尔公司

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    《Urology》 |2015年第3期|共4页
  • 作者

    Vickers Andrew J.;

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