• 四川大學(xué)華西醫(yī)院老年科,成都,610041;

前列腺癌(prostate cancer, PC)是歐美常見男性惡性腫瘤,在我國發(fā)病率也逐年增加,成為威脅老年男性生命的重要疾病.由于缺乏可干預(yù)的危險(xiǎn)因素,早發(fā)現(xiàn)、早治療作為降低前列腺癌死亡率的策略被寄予厚望.現(xiàn)有篩查手段為聯(lián)合血清前列腺特異性抗原(PSA)測定和直腸指檢.目前在普通人群是否進(jìn)行篩查試驗(yàn)還有爭論,缺乏篩查能降低死亡率的一級證據(jù),且發(fā)現(xiàn)的PC最終是否發(fā)展為臨床疾病也有疑問.現(xiàn)有對早期局限性癌的3種治療方法(觀察等待、外照射和外科切除)缺乏有力的隨機(jī)對照試驗(yàn)(RCT)證據(jù)來證實(shí)其利弊.在缺乏篩查試驗(yàn)RCT結(jié)果的情況下,大多數(shù)醫(yī)生推薦進(jìn)行"知情同意"的篩查,即讓醫(yī)生和患者都充分了解和討論可供選擇的早期診斷方法以及篩查的利弊后再做決定.

引用本文： 許揚(yáng),董碧蓉. 關(guān)于前列腺癌普查的爭論. 中國循證醫(yī)學(xué)雜志, 2004, 04(11): 801-805. doi: 復(fù)制

1. ［1］Hsing A, Tsao L, Devesa S. International trends and patterns of prostate cancer incidence and mortality[J]. Int J Cancer, 2000; 85(1): 60-67.
2. ［2］Liu YT, Li YX, Cheng W. The incidence change of urinary tumor[J]. Journal of Clinical Urology, 1997; 12(6): 4748.
3. 劉耀庭, 李秀霞, 程偉. 泌尿外科腫瘤發(fā)病情況的變化[J]. 臨床泌尿外科雜志, 1997; 12(6): 47～48.
4. ［3］Gu FL. Epidemiological survey of benign prostatic hyperplasia and prostate cancer in China[J]. Journal of Beijing Medical University, 2000; 32(1): 3033.
5. 顧方六, 我國良性前列腺增生和前列腺癌發(fā)病調(diào)查[J]. 北京醫(yī)科大學(xué)報(bào), 2000; 32(1): 30～33.
6. ［4］Xu ZB, Wang GM, Sun LA, Zhang YK, The incidence of prostate carcinoma in Shanghai[J]. Clinical Medical Journal of China, 2003; 10(3): 344346.
7. 徐志兵, 王國民, 孫立安, 張永康. 上海市市區(qū)前列腺癌發(fā)病情況調(diào)查分析[J]. 中國臨床醫(yī)學(xué), 2003; 10(3): 344～346.
8. ［5］Von Eschenbach A, Ho R, Murphy GP, Cunningham M, Lins N. American Cancer Society guideline for the early detection of prostate cancer: update 1997[J]. CA Cancer J Clin, 1997; 47(3): 261-264.
9. ［6］Brenda E. Sirovich; Lisa M. Schwartz; Steven Woloshin Screening men for prostate and colorectal cancer in the united states: does practice reflect the evidence?[J]. JAMA, 2003; 289(5): 1 414 -1 420.
10. ［7］Jacobsen SJ, Katusic SK, Berstralh EJ, Oesterling JE. Ohrt D. Klee GG. Chute CG. Lieber MM. Incidence of prostate cancer diagnosis in the eras before and after serum prostate-specific antigen testing[J]. JAMA, 1995; 271(6): 1 445.
11. ［8］Edwards B, Howe H, Ries L, Thun MJ, Rosenberg HM, Yancik R. Annual report to the nation on the status of cancer, 19731999, featuring implications of age and aging on U.S. cancer burden[J]. Cancer, 2002; 94(45): 2 766-2 792.
12. ［9］Brawer MK. Screening for prostate cancer[J]. Sem Surg Oncol 2000; 18(7): 29-36.
13. ［10］W. Sakr, N. Pernick, C. Butler, H. Nassar, V. Pansare, D. Grignon, The prevalence of high grade, clinically occult prostatic adenocarcinoma and its relationship to high grade PIN[M], Abstract 656, American Urological Association, July 2000.
14. ［11］Nam RK, Jewett MAS, Krahn MD. Prostate cancer: 2. Natural history[J].CMAJ,1998; 159(8): 685-691.
15. ［12］Sakr WA, Haas GP, Cassin BJ, Pontes JE, Crissman JD.The frequency of carcinoma and intraepithelial neoplasia of the prostate in young male patients[J]. J Urol, 1993; 150(65): 379-385.
16. ［13］Rosen MA. Impact of prostate-specific antigen screening on the natural history of prostate cancer[J]. Urology, 1995; 46(43): 757-768.
17. ［14］Mistry K. Cable G. Meta-analysis of prostate-specific antigen and digital rectal examination as screening tests for prostate carcinoma[J]. J Am Board Fam Pract. 2003; 16(2): 95-101.
18. ［15］Arjen Hoogendam, Frank Buntinxa, Henrica CW de Vetb. The diagnostic value of digital rectal examination in primary care screening for prostate cancer: a meta-analysis[J]. Family Practice,2003; 16(6): 621-626.
19. ［16］Flanigan RC, Catalona WJ, Richie JP, Ahmann FR, Hudson MA. Accuracy of digital rectal examination and transrectal ultrasonography in localizing prostate cancer[J]. J Urol, 1994; 152(34): 1 506-1 509.
20. ［17］Hammerer P, Huland H. Systematic sextant biopsies in 651 patients referred for prostate evaluation[J]. J Urol,1994; 151(33): 99-102.
21. ［18］Ellis WJ, Chetner MP, Preston SD, Brawer MK. Diagnosis of prostatic carcinoma: the yield of serum prostate specific antigen, digital rectal examination and transrectal ultrasonography[J]. J Urol,1994; 52(2): 1 500-1 525.
22. ［19］Catalona WJ, Smith DS, Ratliff TL, Basler JW. Detection of organ-confined prostate cancer is increased through prostate specific antigen based screening[J]. JAMA,1993; 270(56): 948-954.
23. ［20］Kamoi K, Babaian RJ. Advances in the application of prostate-specific antigen in the detection of early-stage prostate cancer[J]. Sem Oncol, 1999; 26(3): 140-149.
24. ［21］Catalona WJ, Partin AW, Slawin KM. Use of the percentage of free prostatic specific antigen to enhance differentiation of prostate cancer from benign prostatic disease: a prospective multicenter clinical trial[J]. JAMA, 1998; 279(34): 1 542-1 547.
25. ［22］Catalona WJ, Partin AW, Slawin KM. Use of the percentage of free prostatic specific antigen to enhance differentiation of prostate cancer from benign prostatic disease: a prospective multicenter clinical trial[J]. JAMA, 1998; 279(34): 1 542-1 547.
26. ［23］Woodrum DL, Brawer MK, Partin AW, Catalona WJ, Southwick PC. Interpretation of free prostate specific antigen clinical research studies for the detection of prostate cancer[J]. J Urol, 1998; 159(3): 5-12.
27. ［24］Smith DS, Catalona WJ, Herschman JD. Longitudinal screening for prostate cancer with prostate-specific antigen. JAMA, 1996; 276(25): 1 309-1 315.
28. ［25］Keetch DW, Catalona WJ, Smith DS. Serial prostatic biopsies in men with persistently elevated serum prostate specific antigen values[J]. J Urol, 1994; 151(56): 1 571-1 574.
29. ［26］Roehl KA. Antenor JA. Catalona WJ. Serial biopsy results in prostate cancer screening study[J]. J Urol, 2002; 167(6): 2 435-2 439.
30. ［27］Mettlin C, Murphy GP, Babaian RJ. The results of a five-y early prostate cancer detection intervention[J]. Cancer,1996; 77(61): 150-159.
31. ［28］Fowler FJ, Collins MM, Albertsen PC, Zietman A, Alliott DB, Barry MJ. Comparison of recommendations of urologists and radiation oncologists for treatment of clinically localized prostate cancer[J]. JAMA, 2000; 283(7): 3 217-3 222.
32. ［29］Wasson JH, Cushman CC, Bruskewitz RC, Littenberg B, Mulley Jr. AG, Wennberg JE. A structured literature review of treatment for localized prostate cancer[J]. Arch Fam Med,1993; 2(2): 487-493.
33. ［30］Lu-Yao GL, Yao S-L. Population based study of long termsurvival in patients with clinically localised prostate cancer[J]. Lancet , 1997; 349(9 056): 906-910.
34. ［31］Smith DS, Carvalhal GF, Schneider K, Krygiel J, Yan Y, Catalona WJ. Quality-of-life outcomes for men with prostate carcinoma det.ected by screening[J]. Cancer, 2000; 88(16): 1 454-1 463.
35. ［32］Optenberg SA, Thompson IM. Economics of screening for carcinoma of the prostate[J]. Urol Clin NA,1990; 17(4): 719-737.
36. ［33］Catalona WJ, Richie JP, Ahmann FR, Ahmann FR, Hudson MA, et al. Comparison of digital rectal examination and serum prostate specific antigen in the early detection of prostate cancer: results of a multicenter clinical trial of 6,630 men[J]. J Urol, 1994; 151(45): 1 283-1 290.
37. ［34］Svetec D, Thompson IM. PSA screening-current controversy[J]. Ann Oncol,1998; 9: 1 283-1 288.
38. ［35］Benoit RM, Naslund MJ. The economics of prostate cancer screening[J]. Oncology,1997; 11(3): 1 533-1 543.
39. ［36］Grover SA, Zowall H, Coupal L, Krahn MD. Prostate cancer: 12. The economic burden[J]. CMAJ,1999; 160(76): 685-690.
40. ［37］Labrie F, Candas B, Cusan L, Gomez JL, Belanger A, Brousseau G, Chevrette E, Levesque J. Screening decreases prostate cancer mortality: 11-year follow-up of the 1988 Quebec prospective randomized controlled trial[J]. Prostate, 2004; 59(3): 311-318.
41. ［38］Friedman GD, Hiatt RA, Quesenberry CP Jr, Selby JV. Case-control study of screening for prostatic cancer by digital rectal examinations[J]. Lancet,1991; 337(48): 1 526-1 529.
42. ［39］Richert-Boe KE, Humphrey LL, Glass AG, Weiss NS. Screening digital rectal examination and prostate cancer mortality: a case-control study[J]. J Med Screen,1998; 5(2): 99-103.
43. ［40］Jacobsen SJ, Bergstralh EJ, Katusic SK, Guess HA, Darby CH, Silverstein MD, Osterling JE, Lieber MM. Screening digital rectal examination and prostate cancer mortality: a population-based case-control study[J]. Urology,1998; 52(34): 173-179.
44. ［41］Legler JM, Feuer EJ, Potosky AL, Merrill RM, Kramer BS. The role of prostate-specific antigen (PSA) testing patterns in the recent prostate cancer incidence decline in the United States[J]. Cancer Causes Control, 1998; 9(33): 519-527.
45. ［42］Etzioni R, Legler JM, Feuer EJ, Merrill RM, Cronin KA, Hankey BF. Cancer surveillance series: interpreting trends in prostate cancer-part III: Quantifying the link between population prostate-specific antigen testing and recent declines in prostate cancer mortality[J]. J Natl Cancer Inst. 1999; 91(86): 1 033-1 039.
46. ［43］Brawley OW. Prostate carcinoma incidence and patient mortality: the effects of screening and early detection[J]. Cancer,1997; 80(34): 1 857-1 863.
47. ［44］Lu-Yao G, Albertsen PC, Stanford JL, Stukel TA, Walker-Corkery ES, Barry MJ. Natural experiment examining impact of aggressive screening and treatment on prostate cancer mortality in two fixed cohorts from Seattle area and Connecticut[J]. BMJ, 2002; 325(642): 740-745.
48. ［45］Oliver SE, Gunnell D, Donovan JL. Comparison of trends in prostatecancer mortality in England and Wales and the USA[J]. Lancet, 2000; 355(138): 1 788-1 789.
49. ［46］Crocetti E, Ciatto S, Zappa M. Prostate cancer: different incidence but not mortality trends within two areas of Tuscany, Italy[J]. J Natl Cancer Inst, 2001; 93(73): 876-877.
50. ［47］Beemsterboer PMM, de Koning AJ, Kranze R, Trienekens PH, van der Maas PJ, Schroder FH. Prostate specific antigen testing and digital rectal examination before and during a randomized trial of screening for prostate cancer: European Randomized Study of Screening for Prostate Cancer, Rotterdam[J]. J Urol, 2000; 164(32): 1 216-1 220.
51. ［48］Hugosson, J., Aus, G., Becker, C., Carlsson, S., Eriksson, H., Lilja, H., Lodding, P. and Tibblin, G. (2000) Would prostate cancer detected by screening with prostate-specific antigen develop into clinical cancer if left undiagnosed? A comparison of two population-based studies in Sweden[J]. BJU Int, 2000; 85(21): 1 078-1 084.
52. ［49］de Koning HJ, Auvinen A, Berenguer Sanchez AB, Calais da Silva F, Ciatto S, Denis L, Gohagan JK, Hakama M, Hugosson J, Kranse R, Nelen V, Prorok PC, Schroder FH. Large-scale randomized prostate cancer screening trials: program performances in the European Randomized Screening for Prostate Cancer trial and the Prostate, Lung, Colorectal and Ovary cancer trial[J]. Int J Cancer, 2002; 97(11): 237-244.
53. ［50］Wolf AM, Nasser JF, Wolf AM, Schorling JB. The impact of informed consent on patient interest in prostate-specific antigen screening[J]. Arch Intern Med,1996; 156(145): 1 333-1 336.
54. ［51］Volk RJ, Cass AR, Spann SJ. A randomized controlled trial of shared decision making for prostate cancer screening[J]. Arch Fam Med, 1999; 8(14): 333-340.
  1. 1. ［1］Hsing A, Tsao L, Devesa S. International trends and patterns of prostate cancer incidence and mortality[J]. Int J Cancer, 2000; 85(1): 60-67.
  2. 2. ［2］Liu YT, Li YX, Cheng W. The incidence change of urinary tumor[J]. Journal of Clinical Urology, 1997; 12(6): 4748.
  3. 3. 劉耀庭, 李秀霞, 程偉. 泌尿外科腫瘤發(fā)病情況的變化[J]. 臨床泌尿外科雜志, 1997; 12(6): 47～48.
  4. 4. ［3］Gu FL. Epidemiological survey of benign prostatic hyperplasia and prostate cancer in China[J]. Journal of Beijing Medical University, 2000; 32(1): 3033.
  5. 5. 顧方六, 我國良性前列腺增生和前列腺癌發(fā)病調(diào)查[J]. 北京醫(yī)科大學(xué)報(bào), 2000; 32(1): 30～33.
  6. 6. ［4］Xu ZB, Wang GM, Sun LA, Zhang YK, The incidence of prostate carcinoma in Shanghai[J]. Clinical Medical Journal of China, 2003; 10(3): 344346.
  7. 7. 徐志兵, 王國民, 孫立安, 張永康. 上海市市區(qū)前列腺癌發(fā)病情況調(diào)查分析[J]. 中國臨床醫(yī)學(xué), 2003; 10(3): 344～346.
  8. 8. ［5］Von Eschenbach A, Ho R, Murphy GP, Cunningham M, Lins N. American Cancer Society guideline for the early detection of prostate cancer: update 1997[J]. CA Cancer J Clin, 1997; 47(3): 261-264.
  9. 9. ［6］Brenda E. Sirovich; Lisa M. Schwartz; Steven Woloshin Screening men for prostate and colorectal cancer in the united states: does practice reflect the evidence?[J]. JAMA, 2003; 289(5): 1 414 -1 420.
  10. 10. ［7］Jacobsen SJ, Katusic SK, Berstralh EJ, Oesterling JE. Ohrt D. Klee GG. Chute CG. Lieber MM. Incidence of prostate cancer diagnosis in the eras before and after serum prostate-specific antigen testing[J]. JAMA, 1995; 271(6): 1 445.
  11. 11. ［8］Edwards B, Howe H, Ries L, Thun MJ, Rosenberg HM, Yancik R. Annual report to the nation on the status of cancer, 19731999, featuring implications of age and aging on U.S. cancer burden[J]. Cancer, 2002; 94(45): 2 766-2 792.
  12. 12. ［9］Brawer MK. Screening for prostate cancer[J]. Sem Surg Oncol 2000; 18(7): 29-36.
  13. 13. ［10］W. Sakr, N. Pernick, C. Butler, H. Nassar, V. Pansare, D. Grignon, The prevalence of high grade, clinically occult prostatic adenocarcinoma and its relationship to high grade PIN[M], Abstract 656, American Urological Association, July 2000.
  14. 14. ［11］Nam RK, Jewett MAS, Krahn MD. Prostate cancer: 2. Natural history[J].CMAJ,1998; 159(8): 685-691.
  15. 15. ［12］Sakr WA, Haas GP, Cassin BJ, Pontes JE, Crissman JD.The frequency of carcinoma and intraepithelial neoplasia of the prostate in young male patients[J]. J Urol, 1993; 150(65): 379-385.
  16. 16. ［13］Rosen MA. Impact of prostate-specific antigen screening on the natural history of prostate cancer[J]. Urology, 1995; 46(43): 757-768.
  17. 17. ［14］Mistry K. Cable G. Meta-analysis of prostate-specific antigen and digital rectal examination as screening tests for prostate carcinoma[J]. J Am Board Fam Pract. 2003; 16(2): 95-101.
  18. 18. ［15］Arjen Hoogendam, Frank Buntinxa, Henrica CW de Vetb. The diagnostic value of digital rectal examination in primary care screening for prostate cancer: a meta-analysis[J]. Family Practice,2003; 16(6): 621-626.
  19. 19. ［16］Flanigan RC, Catalona WJ, Richie JP, Ahmann FR, Hudson MA. Accuracy of digital rectal examination and transrectal ultrasonography in localizing prostate cancer[J]. J Urol, 1994; 152(34): 1 506-1 509.
  20. 20. ［17］Hammerer P, Huland H. Systematic sextant biopsies in 651 patients referred for prostate evaluation[J]. J Urol,1994; 151(33): 99-102.
  21. 21. ［18］Ellis WJ, Chetner MP, Preston SD, Brawer MK. Diagnosis of prostatic carcinoma: the yield of serum prostate specific antigen, digital rectal examination and transrectal ultrasonography[J]. J Urol,1994; 52(2): 1 500-1 525.
  22. 22. ［19］Catalona WJ, Smith DS, Ratliff TL, Basler JW. Detection of organ-confined prostate cancer is increased through prostate specific antigen based screening[J]. JAMA,1993; 270(56): 948-954.
  23. 23. ［20］Kamoi K, Babaian RJ. Advances in the application of prostate-specific antigen in the detection of early-stage prostate cancer[J]. Sem Oncol, 1999; 26(3): 140-149.
  24. 24. ［21］Catalona WJ, Partin AW, Slawin KM. Use of the percentage of free prostatic specific antigen to enhance differentiation of prostate cancer from benign prostatic disease: a prospective multicenter clinical trial[J]. JAMA, 1998; 279(34): 1 542-1 547.
  25. 25. ［22］Catalona WJ, Partin AW, Slawin KM. Use of the percentage of free prostatic specific antigen to enhance differentiation of prostate cancer from benign prostatic disease: a prospective multicenter clinical trial[J]. JAMA, 1998; 279(34): 1 542-1 547.
  26. 26. ［23］Woodrum DL, Brawer MK, Partin AW, Catalona WJ, Southwick PC. Interpretation of free prostate specific antigen clinical research studies for the detection of prostate cancer[J]. J Urol, 1998; 159(3): 5-12.
  27. 27. ［24］Smith DS, Catalona WJ, Herschman JD. Longitudinal screening for prostate cancer with prostate-specific antigen. JAMA, 1996; 276(25): 1 309-1 315.
  28. 28. ［25］Keetch DW, Catalona WJ, Smith DS. Serial prostatic biopsies in men with persistently elevated serum prostate specific antigen values[J]. J Urol, 1994; 151(56): 1 571-1 574.
  29. 29. ［26］Roehl KA. Antenor JA. Catalona WJ. Serial biopsy results in prostate cancer screening study[J]. J Urol, 2002; 167(6): 2 435-2 439.
  30. 30. ［27］Mettlin C, Murphy GP, Babaian RJ. The results of a five-y early prostate cancer detection intervention[J]. Cancer,1996; 77(61): 150-159.
  31. 31. ［28］Fowler FJ, Collins MM, Albertsen PC, Zietman A, Alliott DB, Barry MJ. Comparison of recommendations of urologists and radiation oncologists for treatment of clinically localized prostate cancer[J]. JAMA, 2000; 283(7): 3 217-3 222.
  32. 32. ［29］Wasson JH, Cushman CC, Bruskewitz RC, Littenberg B, Mulley Jr. AG, Wennberg JE. A structured literature review of treatment for localized prostate cancer[J]. Arch Fam Med,1993; 2(2): 487-493.
  33. 33. ［30］Lu-Yao GL, Yao S-L. Population based study of long termsurvival in patients with clinically localised prostate cancer[J]. Lancet , 1997; 349(9 056): 906-910.
  34. 34. ［31］Smith DS, Carvalhal GF, Schneider K, Krygiel J, Yan Y, Catalona WJ. Quality-of-life outcomes for men with prostate carcinoma det.ected by screening[J]. Cancer, 2000; 88(16): 1 454-1 463.
  35. 35. ［32］Optenberg SA, Thompson IM. Economics of screening for carcinoma of the prostate[J]. Urol Clin NA,1990; 17(4): 719-737.
  36. 36. ［33］Catalona WJ, Richie JP, Ahmann FR, Ahmann FR, Hudson MA, et al. Comparison of digital rectal examination and serum prostate specific antigen in the early detection of prostate cancer: results of a multicenter clinical trial of 6,630 men[J]. J Urol, 1994; 151(45): 1 283-1 290.
  37. 37. ［34］Svetec D, Thompson IM. PSA screening-current controversy[J]. Ann Oncol,1998; 9: 1 283-1 288.
  38. 38. ［35］Benoit RM, Naslund MJ. The economics of prostate cancer screening[J]. Oncology,1997; 11(3): 1 533-1 543.
  39. 39. ［36］Grover SA, Zowall H, Coupal L, Krahn MD. Prostate cancer: 12. The economic burden[J]. CMAJ,1999; 160(76): 685-690.
  40. 40. ［37］Labrie F, Candas B, Cusan L, Gomez JL, Belanger A, Brousseau G, Chevrette E, Levesque J. Screening decreases prostate cancer mortality: 11-year follow-up of the 1988 Quebec prospective randomized controlled trial[J]. Prostate, 2004; 59(3): 311-318.
  41. 41. ［38］Friedman GD, Hiatt RA, Quesenberry CP Jr, Selby JV. Case-control study of screening for prostatic cancer by digital rectal examinations[J]. Lancet,1991; 337(48): 1 526-1 529.
  42. 42. ［39］Richert-Boe KE, Humphrey LL, Glass AG, Weiss NS. Screening digital rectal examination and prostate cancer mortality: a case-control study[J]. J Med Screen,1998; 5(2): 99-103.
  43. 43. ［40］Jacobsen SJ, Bergstralh EJ, Katusic SK, Guess HA, Darby CH, Silverstein MD, Osterling JE, Lieber MM. Screening digital rectal examination and prostate cancer mortality: a population-based case-control study[J]. Urology,1998; 52(34): 173-179.
  44. 44. ［41］Legler JM, Feuer EJ, Potosky AL, Merrill RM, Kramer BS. The role of prostate-specific antigen (PSA) testing patterns in the recent prostate cancer incidence decline in the United States[J]. Cancer Causes Control, 1998; 9(33): 519-527.
  45. 45. ［42］Etzioni R, Legler JM, Feuer EJ, Merrill RM, Cronin KA, Hankey BF. Cancer surveillance series: interpreting trends in prostate cancer-part III: Quantifying the link between population prostate-specific antigen testing and recent declines in prostate cancer mortality[J]. J Natl Cancer Inst. 1999; 91(86): 1 033-1 039.
  46. 46. ［43］Brawley OW. Prostate carcinoma incidence and patient mortality: the effects of screening and early detection[J]. Cancer,1997; 80(34): 1 857-1 863.
  47. 47. ［44］Lu-Yao G, Albertsen PC, Stanford JL, Stukel TA, Walker-Corkery ES, Barry MJ. Natural experiment examining impact of aggressive screening and treatment on prostate cancer mortality in two fixed cohorts from Seattle area and Connecticut[J]. BMJ, 2002; 325(642): 740-745.
  48. 48. ［45］Oliver SE, Gunnell D, Donovan JL. Comparison of trends in prostatecancer mortality in England and Wales and the USA[J]. Lancet, 2000; 355(138): 1 788-1 789.
  49. 49. ［46］Crocetti E, Ciatto S, Zappa M. Prostate cancer: different incidence but not mortality trends within two areas of Tuscany, Italy[J]. J Natl Cancer Inst, 2001; 93(73): 876-877.
  50. 50. ［47］Beemsterboer PMM, de Koning AJ, Kranze R, Trienekens PH, van der Maas PJ, Schroder FH. Prostate specific antigen testing and digital rectal examination before and during a randomized trial of screening for prostate cancer: European Randomized Study of Screening for Prostate Cancer, Rotterdam[J]. J Urol, 2000; 164(32): 1 216-1 220.
  51. 51. ［48］Hugosson, J., Aus, G., Becker, C., Carlsson, S., Eriksson, H., Lilja, H., Lodding, P. and Tibblin, G. (2000) Would prostate cancer detected by screening with prostate-specific antigen develop into clinical cancer if left undiagnosed? A comparison of two population-based studies in Sweden[J]. BJU Int, 2000; 85(21): 1 078-1 084.
  52. 52. ［49］de Koning HJ, Auvinen A, Berenguer Sanchez AB, Calais da Silva F, Ciatto S, Denis L, Gohagan JK, Hakama M, Hugosson J, Kranse R, Nelen V, Prorok PC, Schroder FH. Large-scale randomized prostate cancer screening trials: program performances in the European Randomized Screening for Prostate Cancer trial and the Prostate, Lung, Colorectal and Ovary cancer trial[J]. Int J Cancer, 2002; 97(11): 237-244.
  53. 53. ［50］Wolf AM, Nasser JF, Wolf AM, Schorling JB. The impact of informed consent on patient interest in prostate-specific antigen screening[J]. Arch Intern Med,1996; 156(145): 1 333-1 336.
  54. 54. ［51］Volk RJ, Cass AR, Spann SJ. A randomized controlled trial of shared decision making for prostate cancer screening[J]. Arch Fam Med, 1999; 8(14): 333-340.