超级军网前列腺癌筛查并不适用于所有男性
来源：百度文库 编辑：超级军网 时间：2024/05/06 16:28:11
Prostate Cancer Screening Still Not Recommended for All
By TARA PARKER-POPEAugust 07, 2014
前列腺癌筛查并不适用于所有男性
健康TARA PARKER-POPE2014年08月07日
Stuart Bradford
A major European study has shown that blood test screening for prostate cancer saves lives, but doubts remain about whether the benefit is large enough to offset the harms caused by unnecessary biopsies and treatments that can render men incontinent and impotent.
欧洲的一项重大研究成果显示，通过验血来筛查前列腺癌，可以挽救一些人的生命，但这个益处是否大到足以抵消不必要的活检和治疗给男性带来的危害，比如尿失禁和性功能障碍，仍然存有疑问。
The study, published today in The Lancet, found that midlife screening with the prostate-specific antigen, or PSA, screening test lowers a man’s risk of dying of the disease by 21 percent. The relative benefit sounds sizable, but it is not particularly meaningful to the average middle-age man, whose risk of dying of prostate cancer without screening is about 3 percent. Based on the benefit shown in the study, routine PSA testing would lower his lifetime cancer risk to about 2.4 percent.
这项今日发表在《柳叶刀》(The Lancet)上的研究成果显示，在中年时期接受前列腺特异性抗原(PSA)等方面的筛查，能够令男性死于前列腺癌的风险降低21%。这个相对比例听起来很可观，但对于正常中年男性来说并无太大意义。如果不进行检查，普通中年男性死于前列腺癌的几率大约是3%。按照研究提供的数字，定期进行PSA检查会把他们死于前列腺癌的风险降到2.4%。
Despite the fact that some men —one out of every 781 men in the screening group — were helped by PSA testing in the European study, the study authors say the finding does not support the use of widespread screening. Instead, cancer experts say, the focus should be on screening men at high risk and working to identify nonaggressive cancers so men will not be unnecessarily treated for the disease.
尽管这项研究发现，一些男子从PSA检查中获得了帮助——每781名接受检查的男子就有一人获益，但作者称，并不能据此推广此类筛查。相反，癌症专家说，重点应该是对高风险男性的检查，设法辨别出非侵袭性癌症，这样患有前列腺癌的男子就可以免于不必要的治疗。
“We know we are finding a substantial number of cancers, in the range of 30 to 50 percent, that would never do any harm and would not lead to death’’ said the study’s lead author, the urologist Dr. Fritz H. Schröder from Erasmus University Medical Center in the Netherlands. For every 27 cancers detected by PSA screening, only one man’s life would be saved.
“我们知道，我们正在发现大量不会造成任何危害，也不会致人死亡的癌症，它们的比例在30%到50%之间，”这项研究的主要作者、荷兰伊拉斯谟大学医学中心(Erasmus University Medical Center)泌尿科专家弗里茨·H·施罗德(Fritz H. Schröder )博士说。PSA检查每检测出27例癌症，只有一个人因此免于死亡。
“This overdiagnosis is unacceptable because it also leads to treatment,’’ Dr. Schröder said. “That’s why there is consensus worldwide, with very few exceptions, that the time has not come to recommend population-based screening.”
“这种过度诊断是不可接受的，因为这些诊断也会引发治疗，”施罗德博士说，“这就是为什么全世界都一致认为——几乎没有例外——现在还不适宜建议采取以人群为基础的筛查。”
The findings, based on 13 years of data from a continuing randomized study of 162,000 European men, are certain to create confusion about the relative benefits and risks of the PSA test, which uses a blood sample to identify men at risk for prostate cancer. The test often puts men on a path of repeated biopsies and testing, and for some, treatment of a cancer that would have never caused a problem if left alone. In 2011, the United States Preventive Services Task Force concluded that healthy men should not be screened for prostate cancer, a finding that drastically changed the standard of care for middle-age American men who had grown accustomed to annual screenings.
这些研究成果基于13年来对16.2万欧洲男子随机进行的持续研究。它们毫无疑问引发了关于PSA检测的益处和风险的困惑。该检测利用血样来判断男性是否有患前列腺癌的风险，通常会让男性走上一条反复接受活检和测试的路，有的人还要开始对这种不治疗可能也不会有问题的癌症进行治疗。2011年， 美国预防服务工作组(United States Preventive Services Task Force)断定，健康的男性不应该接受前列腺癌筛查，这一发现彻底地改变了那些习惯每年进行筛查的美国中年男子的谨慎程度。
The task force recommendation against PSA testing was based largely on 10 years of data from two major studies: the United States-based Prostate, Lung, Colorectal and Ovarian (P.L.C.O.) cancer screening trial of 77,000 men, and earlier results from the current study, the European Randomized study of Screening for Prostate Cancer. Additional data collected from the European trial since then has shown a slightly larger benefit over time as a result of screening, along with a still sizable risk of overdiagnosis and overtreatment.
该工作组主要根据两大研究10年以来的数据，得出了不建议接受PSA检查的结论。这两大研究指的是，美国对7.7万名男性开展的前列腺癌、肺癌、结直肠癌和卵巢癌(PLCO)筛查试验，以及当前欧洲前列腺癌筛查随机研究(European Randomized study of Screening for Prostate Cancer)的前期结果。欧洲实验此后提供的其他数据显示，经过一段时间后，筛查带来的好处稍多了一些，但仍存在相当大的过度诊断和过度治疗风险。
“It’s always been a complicated story,’’ said Dr. Ian Thompson,the director of the cancer therapy and research center at the University of Texas Health Science Center at San Antonio, who wrote an accompanying editorial to The Lancet study. Dr. Thompson said that better diagnostic techniques, such as biopsies guided by magnetic resonance imaging tests, along with personalized risk assessment and more informed decision making by men and their doctors were a better way to use the PSA test than to screen every man of a certain age.
德克萨斯大学圣安东尼奥分校健康科学中心(University of Texas Health Science Center in San Antonio)癌症治疗及研究中心主任伊恩·汤普森(Ian Thompson)表示，“这一直是一件非常复杂的事情。”汤普森为《柳叶刀》撰写过一篇相关评论。汤普森表示，与对特定年龄段的所有男性进行筛查相比，利用更好的诊断技术，比如根据磁共振成像测试进行活组织检查，进行针对个人的风险评估，让患者和医生做出更加明智的决定，才是更理想的PSA检查应用。
“The majority of men who get PSA screening will not benefit from it,’’ Dr. Thompson said. “If you do PSA testing in a more sophisticated, contemporary way, there may be the possibility of achieving the mortality reduction while reducing the morbidity impact.”
“大多数接受PSA筛查的男性不会从中受益，”汤普森博士说，“如果以更成熟、现代的方式做PSA检查，还有可能在降低死亡率的同时，减少发病率。”
Doctors say that for men who are confused about whether to get a PSA test, there is hope. New M.R.I. tests to guide targeted prostate biopsies may help find the most aggressive cancers that require treatment, thus identifying men who do not need to be treated.
医生称，对于那些不确定是否参加PSA检查的男人来说，还有别的希望。引导前列腺靶向活检的新核磁振成像测试或许会有助于发现需要治疗的高侵略性癌症，从而确定哪些人不需要治疗。
“The trick is to take the complex nature of the information and provide it to men,” Dr. Thompson said. “A man who is fully informed may say I understand and decide against the test, while another man who watched his father die of prostate cancer may want it.”
“关键在于将信息的复杂本质呈现并告知他们，”汤普森博士说。“一个完全知情的男性或许会说我理解，然后决定不参加检查，但看到自己父亲死于前列腺癌的男性可能会想要参加检查。”
翻译：王湛、许欣
Prostate Cancer Screening Still Not Recommended for All
By TARA PARKER-POPEAugust 07, 2014
前列腺癌筛查并不适用于所有男性
健康TARA PARKER-POPE2014年08月07日
Stuart Bradford
A major European study has shown that blood test screening for prostate cancer saves lives, but doubts remain about whether the benefit is large enough to offset the harms caused by unnecessary biopsies and treatments that can render men incontinent and impotent.
欧洲的一项重大研究成果显示，通过验血来筛查前列腺癌，可以挽救一些人的生命，但这个益处是否大到足以抵消不必要的活检和治疗给男性带来的危害，比如尿失禁和性功能障碍，仍然存有疑问。
The study, published today in The Lancet, found that midlife screening with the prostate-specific antigen, or PSA, screening test lowers a man’s risk of dying of the disease by 21 percent. The relative benefit sounds sizable, but it is not particularly meaningful to the average middle-age man, whose risk of dying of prostate cancer without screening is about 3 percent. Based on the benefit shown in the study, routine PSA testing would lower his lifetime cancer risk to about 2.4 percent.
这项今日发表在《柳叶刀》(The Lancet)上的研究成果显示，在中年时期接受前列腺特异性抗原(PSA)等方面的筛查，能够令男性死于前列腺癌的风险降低21%。这个相对比例听起来很可观，但对于正常中年男性来说并无太大意义。如果不进行检查，普通中年男性死于前列腺癌的几率大约是3%。按照研究提供的数字，定期进行PSA检查会把他们死于前列腺癌的风险降到2.4%。
Despite the fact that some men —one out of every 781 men in the screening group — were helped by PSA testing in the European study, the study authors say the finding does not support the use of widespread screening. Instead, cancer experts say, the focus should be on screening men at high risk and working to identify nonaggressive cancers so men will not be unnecessarily treated for the disease.
尽管这项研究发现，一些男子从PSA检查中获得了帮助——每781名接受检查的男子就有一人获益，但作者称，并不能据此推广此类筛查。相反，癌症专家说，重点应该是对高风险男性的检查，设法辨别出非侵袭性癌症，这样患有前列腺癌的男子就可以免于不必要的治疗。
“We know we are finding a substantial number of cancers, in the range of 30 to 50 percent, that would never do any harm and would not lead to death’’ said the study’s lead author, the urologist Dr. Fritz H. Schröder from Erasmus University Medical Center in the Netherlands. For every 27 cancers detected by PSA screening, only one man’s life would be saved.
“我们知道，我们正在发现大量不会造成任何危害，也不会致人死亡的癌症，它们的比例在30%到50%之间，”这项研究的主要作者、荷兰伊拉斯谟大学医学中心(Erasmus University Medical Center)泌尿科专家弗里茨·H·施罗德(Fritz H. Schröder )博士说。PSA检查每检测出27例癌症，只有一个人因此免于死亡。
“This overdiagnosis is unacceptable because it also leads to treatment,’’ Dr. Schröder said. “That’s why there is consensus worldwide, with very few exceptions, that the time has not come to recommend population-based screening.”
“这种过度诊断是不可接受的，因为这些诊断也会引发治疗，”施罗德博士说，“这就是为什么全世界都一致认为——几乎没有例外——现在还不适宜建议采取以人群为基础的筛查。”
The findings, based on 13 years of data from a continuing randomized study of 162,000 European men, are certain to create confusion about the relative benefits and risks of the PSA test, which uses a blood sample to identify men at risk for prostate cancer. The test often puts men on a path of repeated biopsies and testing, and for some, treatment of a cancer that would have never caused a problem if left alone. In 2011, the United States Preventive Services Task Force concluded that healthy men should not be screened for prostate cancer, a finding that drastically changed the standard of care for middle-age American men who had grown accustomed to annual screenings.
这些研究成果基于13年来对16.2万欧洲男子随机进行的持续研究。它们毫无疑问引发了关于PSA检测的益处和风险的困惑。该检测利用血样来判断男性是否有患前列腺癌的风险，通常会让男性走上一条反复接受活检和测试的路，有的人还要开始对这种不治疗可能也不会有问题的癌症进行治疗。2011年， 美国预防服务工作组(United States Preventive Services Task Force)断定，健康的男性不应该接受前列腺癌筛查，这一发现彻底地改变了那些习惯每年进行筛查的美国中年男子的谨慎程度。
The task force recommendation against PSA testing was based largely on 10 years of data from two major studies: the United States-based Prostate, Lung, Colorectal and Ovarian (P.L.C.O.) cancer screening trial of 77,000 men, and earlier results from the current study, the European Randomized study of Screening for Prostate Cancer. Additional data collected from the European trial since then has shown a slightly larger benefit over time as a result of screening, along with a still sizable risk of overdiagnosis and overtreatment.
该工作组主要根据两大研究10年以来的数据，得出了不建议接受PSA检查的结论。这两大研究指的是，美国对7.7万名男性开展的前列腺癌、肺癌、结直肠癌和卵巢癌(PLCO)筛查试验，以及当前欧洲前列腺癌筛查随机研究(European Randomized study of Screening for Prostate Cancer)的前期结果。欧洲实验此后提供的其他数据显示，经过一段时间后，筛查带来的好处稍多了一些，但仍存在相当大的过度诊断和过度治疗风险。
“It’s always been a complicated story,’’ said Dr. Ian Thompson,the director of the cancer therapy and research center at the University of Texas Health Science Center at San Antonio, who wrote an accompanying editorial to The Lancet study. Dr. Thompson said that better diagnostic techniques, such as biopsies guided by magnetic resonance imaging tests, along with personalized risk assessment and more informed decision making by men and their doctors were a better way to use the PSA test than to screen every man of a certain age.
德克萨斯大学圣安东尼奥分校健康科学中心(University of Texas Health Science Center in San Antonio)癌症治疗及研究中心主任伊恩·汤普森(Ian Thompson)表示，“这一直是一件非常复杂的事情。”汤普森为《柳叶刀》撰写过一篇相关评论。汤普森表示，与对特定年龄段的所有男性进行筛查相比，利用更好的诊断技术，比如根据磁共振成像测试进行活组织检查，进行针对个人的风险评估，让患者和医生做出更加明智的决定，才是更理想的PSA检查应用。
“The majority of men who get PSA screening will not benefit from it,’’ Dr. Thompson said. “If you do PSA testing in a more sophisticated, contemporary way, there may be the possibility of achieving the mortality reduction while reducing the morbidity impact.”
“大多数接受PSA筛查的男性不会从中受益，”汤普森博士说，“如果以更成熟、现代的方式做PSA检查，还有可能在降低死亡率的同时，减少发病率。”
Doctors say that for men who are confused about whether to get a PSA test, there is hope. New M.R.I. tests to guide targeted prostate biopsies may help find the most aggressive cancers that require treatment, thus identifying men who do not need to be treated.
医生称，对于那些不确定是否参加PSA检查的男人来说，还有别的希望。引导前列腺靶向活检的新核磁振成像测试或许会有助于发现需要治疗的高侵略性癌症，从而确定哪些人不需要治疗。
“The trick is to take the complex nature of the information and provide it to men,” Dr. Thompson said. “A man who is fully informed may say I understand and decide against the test, while another man who watched his father die of prostate cancer may want it.”
“关键在于将信息的复杂本质呈现并告知他们，”汤普森博士说。“一个完全知情的男性或许会说我理解，然后决定不参加检查，但看到自己父亲死于前列腺癌的男性可能会想要参加检查。”
翻译：王湛、许欣