fa غربالگری با آنتی ژن اختصاصی پروستات (PSA) عمومى General پژوهشي Research <span style="font-size:12.5pt"><span style="line-height:17pt"><span style="direction:rtl"><span style="unicode-bidi:embed"><span b="" mitra="" style="font-family:"><span style="color:black"><b><span lang="FA" style="letter-spacing:-.1pt">زمینه:</span></b> کانسر پروستات یکی از سرطان<span calibri="" dir="LTR" style="font-family:">‌</span>های شایع در ایران است استفاده از <span class="latin" new="" roman="" style="font-family:" times=""><span dir="LTR" style="font-size:10.0pt">PSA</span></span> (آنتی ژن اختصاصی پروستات) به عنوان غربالگری مورد توافق همه نمی باشد زیرا در اغلب موارد <span class="latin" new="" roman="" style="font-family:" times=""><span dir="LTR" style="font-size:10.0pt">PSA</span></span>&nbsp; موجب شناسایی مواردی از کانسر پروستات می شود که نیاز به درمان ندارند و موجب افزایش عوارض ناشی از درمان&nbsp; در این گروه از بیماران می<span calibri="" dir="LTR" style="font-family:">‌</span>گردد و از طرفی عدم غربالگری موجب افزایش کانسرهای پروستات متاستاتیک می<span calibri="" dir="LTR" style="font-family:">‌</span>شود. <span style="letter-spacing:-.1pt" lang="FA"></span></span></span></span></span></span></span><br> <span style="font-size:12.5pt"><span style="line-height:17pt"><span style="direction:rtl"><span style="unicode-bidi:embed"><span b="" mitra="" style="font-family:"><span style="color:black"><b><span lang="FA" style="letter-spacing:-.1pt">روش کار:</span></b> با استفاده از کلمات کلیدی <span class="latin" new="" roman="" style="font-family:" times=""><span dir="LTR" style="font-size:10.0pt">PSA</span></span> و <span class="latin" new="" roman="" style="font-family:" times=""><span dir="LTR" style="font-size:10.0pt">Prostate Cancer</span></span> و <span class="latin" new="" roman="" style="font-family:" times=""><span dir="LTR" style="font-size:10.0pt"><span minion="" pro="" style="font-family:">Screen</span></span></span> در بانک اطلاعاتی <span class="latin" new="" roman="" style="font-family:" times=""><span dir="LTR" style="font-size:10.0pt"><span minion="" pro="" style="font-family:">PubMed </span></span></span>جستجو انجام شد و مطالعات کارآزمایی وارد مطالعه شدند و مطالعات <span class="latin" new="" roman="" style="font-family:" times=""><span dir="LTR" style="font-size:10.0pt">cohort</span></span>، مروری و گزارش موردی از مطالعه حذف شدند. 301 مقاله پیدا شد و مقالات انگلیسی زبان وارد مطالعه شدند. چهار سوال در مورد منافع و مضرات <span class="latin" new="" roman="" style="font-family:" times=""><span dir="LTR" style="font-size:10.0pt">PSA</span></span> <span class="latin" new="" roman="" style="font-family:" times=""><span dir="LTR" style="font-size:10.0pt">screening</span></span> و منافع و مضرات درمان کانسر پروستات لوکالیزه مورد بررسی قرار گرفت که در نهایت 15 مقاله انتخاب و مورد بررسی قرار گرفت. همچنین منابع مقالات هم بررسی شد و اگر مقاله ای مرتبط به موضوع مورد بحث بود اضافه شد.<span style="letter-spacing:-.1pt"></span></span></span></span></span></span></span><br> <span style="font-size:12.5pt"><span style="line-height:17pt"><span style="direction:rtl"><span style="unicode-bidi:embed"><span b="" mitra="" style="font-family:"><span style="color:black"><b><span lang="FA" style="letter-spacing:-.1pt">یافته</span></b><b><span calibri="" dir="LTR" style="font-family:"><span style="letter-spacing:-.1pt">‌</span></span><span lang="FA" style="letter-spacing:-.1pt">ها:</span></b> دو مطالعه <span class="latin" new="" roman="" style="font-family:" times=""><span dir="LTR" style="font-size:10.0pt">PLCO </span></span>و <span class="latin" new="" roman="" style="font-family:" times=""><span dir="LTR" style="font-size:10.0pt">CAP </span></span>نشان دادند که غربالگری با<span class="latin" new="" roman="" style="font-family:" times=""><span dir="LTR" style="font-size:10.0pt"> PSA</span></span> موجب کاهش مرگ ومیر کانسر پروستات نشده است اما مطالعه <span class="latin" new="" roman="" style="font-family:" times=""><span dir="LTR" style="font-size:10.0pt">ERSPC</span></span> کاهش 21 درصد در مورتالیتی کانسر پروستات را نشان داد. مهمترین مشکل درزمینه غربالگری کانسر پروستات، تشخیص بیش از حد کانسر پروستات <span class="latin" new="" roman="" style="font-family:" times=""><span dir="LTR" style="font-size:10.0pt">(overdiagnosis)</span></span> میباشد. در این مطالعات 7/20 <span class="latin" new="" roman="" style="font-family:" times=""><span dir="LTR" style="font-size:10.0pt">%</span></span> تا 4/50 <span class="latin" new="" roman="" style="font-family:" times=""><span dir="LTR" style="font-size:10.0pt">%</span></span> بیماران دچار تشخیص بیش از حد شده بودند.<span style="letter-spacing:-.1pt"> در کارآزمایی </span><span class="latin" new="" roman="" style="font-family:" times=""><span dir="LTR" style="font-size:10.0pt"><span style="letter-spacing:-.1pt">PIVOT </span></span></span><span lang="FA" style="letter-spacing:-.1pt">و</span><span class="latin" new="" roman="" style="font-family:" times=""><span dir="LTR" style="font-size:10.0pt"><span style="letter-spacing:-.1pt"> PROTECT</span></span></span><span style="letter-spacing:-.1pt"> درمان کانسر پروستات که با </span><span class="latin" new="" roman="" style="font-family:" times=""><span dir="LTR" style="font-size:10.0pt">PSA</span></span> <span class="latin" new="" roman="" style="font-family:" times=""><span dir="LTR" style="font-size:10.0pt">Screening</span></span> پیدا شده اند موجب افزایش بقا نشده بود اما در کارآزمایی <span class="latin" new="" roman="" style="font-family:" times=""><span dir="LTR" style="font-size:10.0pt">SPCG-4</span></span> درمان کانسر پروستات لوکالیزه موجب افزایش بقا شده بود.<span class="latin" new="" roman="" style="font-family:" times=""><span dir="LTR" style="font-size:10.0pt"><span style="font-family:"Calibri","sans-serif""></span></span></span></span></span></span></span></span></span><br> <b><span dir="RTL" lang="AR-SA" style="font-size:11.0pt"><span style="line-height:107%"><span arial="" style="font-family:"><span style="letter-spacing:-.1pt">نتیجه</span></span></span></span><span style="font-size:11.0pt"><span style="line-height:107%"><span calibri="" style="font-family:"><span style="letter-spacing:-.1pt">‌</span></span></span></span><span dir="RTL" lang="AR-SA" style="font-size:11.0pt"><span style="line-height:107%"><span arial="" style="font-family:"><span style="letter-spacing:-.1pt">گیری:</span></span></span></span></b> <span dir="RTL" lang="AR-SA" style="font-size:11.0pt"><span style="line-height:107%"><span arial="" style="font-family:"><span style="letter-spacing:-.25pt">با به کار بردن روش درمان فعال</span></span></span></span><span class="latin" new="" roman="" style="font-family:" times=""><span style="font-size:10.0pt"><span style="line-height:107%"><span style="letter-spacing:-.2pt">(active surveillance)</span></span></span></span><span dir="RTL" style="font-size:11.0pt"><span style="line-height:107%"><span arial="" style="font-family:"><span style="letter-spacing:-.25pt"> در موارد کانسر پروستات با ریسک کم یا استفاده از تستهای تکمیلی مثل </span></span></span></span>&nbsp;&nbsp;<span class="latin" new="" roman="" style="font-family:" times=""><span style="font-size:10.0pt"><span style="line-height:107%"><span style="letter-spacing:-.2pt">(</span></span></span><span style="font-size:10.0pt"><span style="line-height:107%"><span style="letter-spacing:-.1pt">PHI (prostate health index </span></span></span></span><span dir="RTL" lang="AR-SA" style="font-size:11.0pt"><span style="line-height:107%"><span arial="" style="font-family:"><span style="letter-spacing:-.1pt">و </span></span></span></span><span class="latin" new="" roman="" style="font-family:" times=""><span style="font-size:10.0pt"><span style="line-height:107%"><span style="letter-spacing:-.1pt">Multiparametric MRI </span></span></span></span><span dir="RTL" style="font-size:11.0pt"><span style="line-height:107%"><span arial="" style="font-family:"><span style="letter-spacing:-.1pt">&nbsp;در مواردی که </span></span></span></span><span class="latin" new="" roman="" style="font-family:" times=""><span style="font-size:10.0pt"><span style="line-height:107%"><span style="letter-spacing:-.1pt">PSA</span></span></span></span><span dir="RTL" style="font-size:11.0pt"><span style="line-height:107%"><span arial="" style="font-family:"><span style="letter-spacing:-.1pt"> کمی بالاتر از حد طبیعی است، انجام </span></span></span></span><span class="latin" new="" roman="" style="font-family:" times=""><span style="font-size:10.0pt"><span style="line-height:107%"><span style="letter-spacing:-.1pt">PSA</span></span></span></span><span dir="RTL" style="font-size:11.0pt"><span style="line-height:107%"><span arial="" style="font-family:"><span style="letter-spacing:-.1pt"> برای غربالگری توصیه می</span></span></span></span><span dir="RTL" lang="AR-SA" style="font-size:11.0pt"><span style="line-height:107%"><span arial="" style="font-family:"> شود. </span></span></span> <span style="font-size:12pt"><span style="line-height:13pt"><span style="font-family:IRMitra"><span style="color:black"><span style="font-weight:bold"><span style="font-family:"Times New Roman","serif""></span></span></span></span></span></span><br> <span style="font-size:12pt"><span style="line-height:13pt"><span style="font-family:IRMitra"><span style="color:black"><span style="font-weight:bold"><span new="" roman="" style="font-family:" times="">Introduction: Prostate cancer is one of the most common cancers in Iranian men. PSA(prostate specific antigen) screening is a controversial issue because PSA screening leads to diagnose of patients with low risk prostate cancer who not only do not benefit from treatment but also suffer from complication caused by treatment. On the other hand, without prostate cancer screening, the rate of metastatic prostate cancer will increase. This article is a narrative review article on PSA screening, reviewing clinical trial articles in the PubMed. </span></span></span></span></span></span><br> <span style="font-size:12pt"><span style="line-height:13pt"><span style="font-family:IRMitra"><span style="color:black"><span style="font-weight:bold"><span new="" roman="" style="font-family:" times="">Methods: We searched PubMed using keywords: &ldquo;PSA, Prostate Cancer and&nbsp; Screen&rdquo; and English as well as full text articles were included. Only clinical trial studies were included. Case studies, cohort studies and review articles were excluded. 301 articles were found. Our emphasis was on four questions on benefits and harms of PSA screening and benefits and harms of prostate cancer treatment for localized prostate cancer were reviewed. Finally 15 articles were included. References from included studies were manually reviewed to identify additional studies of interest. </span></span></span></span></span></span><br> <span style="font-size:12pt"><span style="line-height:13pt"><span style="font-family:IRMitra"><span style="color:black"><span style="font-weight:bold"><span new="" roman="" style="font-family:" times="">Results: PLCO AND CAP studies showed that PSA screening does not lead to decreased prostate cancer mortality but ERSPC study showed 21% decrease in prostate cancer mortality among people who screen for prostate cancer. The most problem in prostate cancer screening is over diagnosis. These studies revealed over diagnosis in 20.7% to 50.4% of patients who were screened with PSA. Pivot and PROTECT studies revealed radical prostatectomy for patients with localized prostate cancer detected with PSA screening, does not significantly increase the survival of prostate cancer, however; SPCG-4 study showed that radical prostatectomy significantly increased survival of localized prostate cancer.</span></span></span></span></span></span><br> <span style="font-size:12pt"><span style="line-height:13pt"><span style="font-family:IRMitra"><span style="color:black"><span style="font-weight:bold"><span new="" roman="" style="font-family:" times="">Conclusion: Active surveillance of low-risk prostate cancer or supplemental tests such as PHI (prostate health index) and Multiparametric MRI in cases where PSA is slightly higher than normal is recommended for PSA screening. </span></span></span></span></span></span><br> &nbsp; غربالگری, پروستات, آنتی ژن اختصاصی پروستات PSA, سرطان پروستات Prostate cancer, Screening, PSA 159 163 http://jmciri.ir/browse.php?a_code=A-10-1-2674&slc_lang=fa&sid=1 سید علی حجتی 10031947532846006602 10031947532846006602 Yes بیمارستان شهدای تجریش امیررضا عابدی 10031947532846006603 10031947532846006603 No بیمارستان شهدای تجریش