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英格兰前列腺特异性抗原检测存在过度检查的风险
作者:小柯机器人 发布时间:2025/10/10 10:22:29

近日,英国牛津大学Brian D Nicholson团队研究了英格兰前列腺特异性抗原复测间隔和趋势:基于人群的队列研究。相关论文于2025年10月8日发表在《英国医学杂志》上。

为了探讨前列腺特异性抗原(PSA)检测在英格兰初级保健中的应用,研究组在英格兰进行了一项基于人群的开放式队列研究。2000年至2018年期间,共有10235805名18岁以上的男性患者在1442家全科诊所注册,为临床实践研究数据链做出了贡献。数据与国家癌症登记处、医院事件统计和国家统计办公室相关联。使用年龄标准化PSA检测率分析基于人口的时间趋势和年度百分比变化。混合效应负二项回归模型研究了PSA检测的个体患者率比。线性混合效应模型检验了与个体患者PSA重测间隔长度相关的因素。

按地区、剥夺、年龄、种族、前列腺癌家族史、症状表现和PSA值进行分析。1521116名患者至少进行了一次PSA检测,总共进行了3835440次PSA检测。这些患者中有48.4%(735750)进行了多次检测,其中72.8%(535990)的PSA值从未超过特定年龄的转诊阈值。总体上,中位复测间隔为12.6个月(四分位数间距为6.2-27.5)。检测率因地区、剥夺、种族、家族史、年龄、PSA值和症状而异。一旦检测,如果患者年龄较大、属于白人以外的种族、有前列腺癌症家族史或之前PSA水平升高,则重新检测间隔较短。尽管不同地区和剥夺条件下的检测率存在相当大的差异,但这些组的重新检测间隔时间相似。

研究结果表明,在英格兰的初级保健中,前列腺癌诊断前的PSA检测各不相同。在接受多次检查的患者中,许多人的检查频率高于建议,这引发了对过度检查的担忧。在没有症状记录的患者和PSA值较低的患者中进行PSA重新检测。为了确保患者获得最大的利益,同时减少过度检测的风险,迫切需要研究确定适当的基于证据的PSA重新检测间隔。

附:英文原文

Title: Prostate specific antigen retesting intervals and trends in England: population based cohort study

Author: Kiana K Collins, Jason L Oke, Pradeep S Virdee, Rafael Perera, Brian D Nicholson

Issue&Volume: 2025/10/08

Abstract:

Objective To characterise the use of the prostate specific antigen (PSA) test in primary care in England.

Design Population based open cohort study.

Setting England.

Participants 10235805 male patients older than 18 years and registered at 1442 general practices that contributed to the Clinical Practice Research Datalink between 2000 and 2018. Data were linked to the National Cancer Registry, Hospital Episode Statistics, and Office for National Statistics.

Main outcome measures Population based temporal trends and annual percentage changes were analysed using age standardised PSA testing rates. Mixed effects negative binomial regression models investigated individual patient rate ratios of PSA testing. Linear mixed effects models examined factors associated with an individual patient’s length of PSA retesting intervals. All results were analysed by region, deprivation, age, ethnicity, family history of prostate cancer, symptom presentation, and PSA value.

Results 1521116 patients had at least one PSA test, resulting in 3835440 PSA tests overall. 48.4% (735750) of these patients had multiple tests and 72.8% (535990) of them never presented with a PSA value above the age specific referral threshold. The median retesting interval overall was 12.6 months (interquartile range 6.2-27.5). Testing rates varied by region, deprivation, ethnicity, family history, age, PSA value, and symptoms. Once tested, patients had shorter retesting intervals if they were older, were of an ethnicity other than white, had a family history of prostate cancer, or had previously raised PSA levels. Despite considerable variation in testing rates by region and deprivation, the length of retesting intervals was similar across these groups.

Conclusions PSA testing before a diagnosis of prostate cancer in primary care in England varied. Among patients who underwent multiple tests, many were tested more frequently than recommended, raising concerns about overtesting. PSA retesting is occurring in patients without recorded symptoms and in those with low PSA values. To ensure maximum benefit to patients while reducing the risk of overtesting, research is urgently needed to determine appropriate evidence based PSA retesting intervals.

DOI: 10.1136/bmj-2024-083800

Source: https://www.bmj.com/content/391/bmj-2024-083800

期刊信息

BMJ-British Medical Journal:《英国医学杂志》,创刊于1840年。隶属于BMJ出版集团,最新IF:93.333
官方网址:http://www.bmj.com/
投稿链接:https://mc.manuscriptcentral.com/bmj