男性究竟該不該做前列腺癌篩查大綱
Fewer men are being screened for prostate cancer, and fewer early-stage cases are being detected, according to two studies published Tuesday in The Journal of the American Medical Association.
11月17日發表在《美國醫學協會雜誌》(Journal of the American Medical Association)上的兩項研究指出，接受前列腺癌篩查的人數有所減少，早期病例的檢出量也在減少。
The number of cases has dropped not because the disease is becoming less common but because there is less effort to find it, the researchers said.
研究人員稱，病例數減少並非是因爲患病率正在下降，而是因爲人們不像以往那麼注意去檢測這種疾病了。
The declines in both screening and incidence “could have significant public health implications,” the authors of one of the studies wrote, but they added that it was too soon to tell whether the changes would affect death rates from the disease.
其中一項研究的作者們寫道，篩查和發病率的下降“可能具有重大的公共衛生意義”，但他們也補充說，要斷言這一變化是否會影響該疾病的死亡率還爲時過早。
About 220,800 new cases of prostate cancer are expected in 2015, along with 27,540 deaths, according to the American Cancer Society.
美國癌症協會(American Cancer Society)預計，2015年新發前列腺癌病例可達220800例，病死27540例。
Screening for prostate cancer, like mammography for breast cancer, has long been a subject of intense debate, with advocates insisting that it saves lives and detractors arguing that it leads to too much unnecessary treatment.
與使用乳腺攝影篩查乳腺癌一樣，前列腺癌篩查長期以來也一直飽受爭議，支持者們堅稱它可以挽救生命，反對者則認爲它會導致過多不必要的治療。
The decrease in testing is almost certainly a result of a recommendation against screening made in 2012 by the United States Preventive Services Task Force. The task force, an independent panel of experts picked by the government, found that risks outweighed the benefits of routine blood tests for prostate-specific antigen, or PSA, a protein associated with prostate cancer.
幾乎可以肯定，近期篩查測試的減少是2012年美國預防服務工作組(United States Preventive Services Task Force)提出建議反對篩查的結果。這一由政府挑選的獨立專家小組發現，對前列腺特異性抗原（PSA，一種前列腺癌相關的蛋白質）進行常規驗血檢查的風險遠遠超過了其效益。
Because prostate cancer often grows slowly, the panel said, screening finds many tumors that might never have harmed the patient. But they are treated anyway. As a result, it concluded, testing saves few lives and leads too many men into unneeded surgery or radiation, which often leaves them impotent and incontinent.
該工作組指出，由於前列腺癌通常進展緩慢，篩查發現的許多腫瘤可能永遠也不會對患者造成損害。但它們還是受到了治療。因此，該檢測救人不多，卻害得太多人接受了不必要的手術或放療，以致於陽痿或尿失禁。
An editorial accompanying the articles, by Dr. David F. Penson, the chairman of urologic surgery at Vanderbilt University Medical Center, acknowledged that too much screening could do harm but suggested that the pendulum had swung too far the other way.
範德堡大學醫學中心(Vanderbilt University Medical Center)的泌尿外科主任戴維·F·彭森(David F. Penson)博士在隨新研究刊發的評論文章中承認篩查過多可能有害，但也不至於像現在認爲的那麼誇張。
Rather than issuing a blanket recommendation against screening, Dr. Penson said, it would be better to “screen smarter” by testing most men less often and focusing more on those at high risk.
彭森博士並沒有泛泛地建議反對篩查，相反，他認爲更好的應對方法是“智慧地篩查”，即擴大篩查面，降低篩查頻率，且更加關注高危人羣。
One of the new studies, by researchers from the American Cancer Society, found that early-stage diagnoses of prostate cancer per 100,000 men age 50 and older dropped to 416.2 in 2012, from 540.8 cases in 2008, with the biggest decrease occurring from 2011 to 2012 — after a draft of the task force guidelines was released in October 2011. The authors estimated that the total number of diagnoses decreased to 180,043 in 2012 from 213,562 in 2011 — a difference of 33,519 cases.
其中一項新研究由美國癌症協會的研究人員完成，他們發現，前列腺癌的早期診斷率從2008年的每10萬名年滿50歲男性540.8例下降到了2012年的416.2例，最大的下降發生在2011年至2012年間，也就是2011年10月該工作組的指南發佈之後。按照研究作者們的估算，總確診病例數從2011年的213562例減少到了2012年的180043例，相差33519例。
That difference may indicate that many men were spared needless treatment — exactly what the task force had hoped to accomplish with its guidelines. But the authors also said, “Less screening or discontinuing screening may lead to missed opportunities for detecting biologically important lesions at an early stage and preventing deaths from prostate cancer.”
該差異可能代表有許多人避免了不必要的治療，這也是該工作組希望其指南達到的目標。但作者們表示，“減少或中止篩查可能錯失時機，以致未能在早期階段發現具有重要生物學意義的病變，從而預防因前列腺癌死亡。”
The percentage of men 50 and older who reported PSA screening in the previous 12 months dropped to 30.8 percent in 2013, from 37.8 percent in 2010.
在年滿50歲的男性中，報告在過去12個月內進行過PSA篩查者的比例從2010年的37.8%下降到了2013年的30.8%。
Although the study could not prove that the drop in screening caused the drop in diagnoses, the authors said it was the most plausible explanation.
儘管這項研究無法證明是篩查的減少導致了診斷數的下降，但作者們認爲這是最合理的解釋。
The findings were based on data from cancer registries and national surveys that asked men about prostate screening.
上述研究結果依據的是來自癌症登記局和有關前列腺篩查的全國性調查的數據。
A second study, by researchers from several medical centers, also found a significant decline in PSA testing after the 2012 task force recommendations.
在另一項研究中，多家醫療中心的研究人員也發現，自2012年工作組提出建議後，PSA檢測顯著減少了。
“With PSA testing, we often detect cancers that don’t need to be treated — clinically indolent, meaningless cancers,” Dr. Penson said in an interview. “It is true that more men die with prostate cancer than of it.”
“在PSA檢測中，我們經常會發現臨牀上不活躍，也就是沒有治療意義的癌症，”彭森博士在接受採訪時說。“但死於前列腺癌的男性要多於此，這也是事實。”
He said the recognition that many prostate cancers were indolent, or slow-growing, and not deadly had led to major changes in medical practice, making doctors less inclined to automatically operate if cancer is found.
他說，認識到許多前列腺癌並不活躍/生長緩慢/並不致命導致了醫療實踐中的重大改變，醫生們不像過去那樣一發現癌症就不假思索地準備做手術。
The cancer society recommends that men discuss screening with their doctors to decide whether they should have it.
癌症協會建議男人們與他們的醫生討論後再決定是否應該接受篩查。
Some men, told the pros and cons, decide against having any screening. Others opt for the testing, and if cancer is found, want it removed even though it might not be deadly.
有些人在權衡利弊後決定不進行篩查。其他人則選擇接受檢測，而且，一旦發現癌症就立即切除——哪怕它可能並不致命。
But some who choose to be tested prefer another approach if cancer is found: “active surveillance,” which may involve repeated PSA tests and a biopsy every other year to find out if the cancer is growing and becoming more aggressive.
不過，也有一些選擇接受檢測的人傾向於在發現癌症後採取另一種方法：“主動監測”，包括多次PSA檢測、每隔一年進行活檢以確認癌症的生長情況，以及它是否正變得更有侵襲性。
Dr. James A. Eastham, the chief of the urology service at Memorial Sloan Kettering Cancer Center in New York, said two long-term studies had shown that this type of monitoring was a reasonable way to determine which patients needed treatment. Most patients considered low-risk turned out to have very low rates of cancer progression.
紐約紀念斯隆·凱特琳癌症中心(Memorial Sloan Kettering Cancer Center)的泌尿科主任詹姆斯·A·伊斯特漢(James A. Eastham)博士指出，兩項長期研究表明，這種監測是識別哪些患者需要治療的合適方法。大多數低風險患者的癌症進展率都非常低。
“Some do go on to treatment eventually, but the majority do not die of prostate cancer,” Dr. Eastham said. About 2 percent do die from the disease, he added. And he said that even with the best possible active surveillance, some patients will still be overtreated.
“一部分人最後還是去治療了，但大多數人都沒有因前列腺癌而死。”伊斯特漢博士說，大約2%的人死於這種疾病。他還說，即使在最好的主動監測之下，仍然會有一些患者被過度治療。
Dr. Penson said that when active surveillance is explained, “of course men look and say, ‘That would be great if I can avoid having surgery or radiation.’ ”
彭森博士說，在向人們解釋主動監測時，“他們當然會說：‘要是能避免手術和放療，那感情敢情好。’ ”
“ ‘If you think this cancer is not a problem, Doc, I’ll take that every day and Sunday.’ It’s not hard to convince patients,” Dr. Penson added.
“他們會說：‘如果醫生你覺得這處癌症沒什麼大不了的，我願意天天監測。’所以要說服患者並不難。”彭森博士補充道。
Dr. Eastham and Dr. Penson said there had been two extremes in testing, neither satisfactory. First, doctors screened all men over 50 with PSA tests and operated on all cancers. But now they may be heading toward the other extreme of not screening anybody.
伊斯特漢博士和彭森博士表示，對待PSA檢測出現過兩個極端態度，它們都不盡如人意。早先是醫生對所有50歲以上的男性都進行篩查，並對所有癌症都予以手術治療。而今卻又可能會走向對任何人都不篩查的另一個極端。
Both doctors said that screening should be based on a man’s preferences and individual risk, and that better ways to screen were needed, methods that would let doctors zero in on the cancers that needed to be treated and could be cured. Promising new imaging techniques and blood tests for biomarkers that would reveal cancer are in the works, they said.
兩位博士都認爲，篩查應基於個人偏好和個體風險，且需要更好的篩查方式，讓醫生可以將注意力集中在需要加以治療且可以治癒的癌症之上。他們說，新的頗具前途的成像技術和生物標記物血液檢測均在研究當中。
“But they’re not ready for prime time, so we’re stuck with the hand we’ve been dealt, the PSA test, which is an imperfect test,” Dr. Penson said. “But we can do a better job with it.”
“但它們還不夠成熟，所以我們只能將就使用手頭現有的這個差強人意的PSA檢測，”彭森博士說。“不過，我們可以更好地利用它。”
