Pemeriksaan Antigen Spesifik Prostat (PSA) untuk Deteksi Dini Kanker Prostat: Analisis Berbasis Bukti
Tinjauan Pustaka
DOI:
https://doi.org/10.55175/cdk.v53i07.1981Kata Kunci:
Deteksi dini, kanker prostat, skrining PSA, pedoman skriningAbstrak
Pendahuluan: Skrining antigen spesifik prostat (PSA) telah mengubah strategi deteksi dini kanker prostat, namun penerapannya secara luas masih kontroversial karena kekhawatiran diagnosis berlebihan, pengobatan berlebihan, dan manfaat mortalitas yang dipertanyakan. Artikel ini mengevaluasi bukti kontemporer manfaat dan bahaya skrining berbasis PSA, mensintesis temuan dari uji klinis utama, analisis efektivitas biaya, dan pedoman internasional. Metode: Analisis berbasis bukti menggunakan data uji coba ERSPC, bersama dengan meta-analisis terkini, kemajuan biomarker, protokol berbasis MRI, dan pedoman skrining nasional dari USPSTF, EAU, NCCN, dan lainnya. Hasil: Skrining PSA dapat mengurangi mortalitas spesifik kanker prostat, terutama pada pria berusia 55–69 tahun. Skrining ini memfasilitasi deteksi dini, meningkatkan akses terapi kuratif, dan mendorong keterlibatan kesehatan yang lebih luas. Namun, skrining ini memiliki risiko signifikan, termasuk diagnosis berlebih tumor indolen, morbiditas terkait pengobatan berlebih, hasil positif palsu, tekanan psikologis, dan beban ekonomi. Hasil mortalitas di berbagai studi masih belum konsisten, mendorong pergeseran ke arah skrining yang dipersonalisasi dan disesuaikan dengan risiko yang dipandu oleh usia, komorbiditas, riwayat keluarga, biomarker (misalnya PHI, 4Kscore), dan MRI multiparametrik. Simpulan: Skrining PSA tidak boleh diterapkan secara universal, melainkan melalui pengambilan keputusan bersama dan penilaian risiko individual. Penelitian lanjutan diperlukan untuk mengoptimalkan hasil dan menginformasikan kebijakan skrining yang adil, terutama di wilayah dengan sumber daya terbatas.
Unduhan
Referensi
Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209–49. doi: 10.3322/caac.21660
Carlsson S, Vickers AJ, Roobol M, Eastham J, Scardino P, Lilja H, et al. Prostate cancer screening: facts, statistics, and interpretation in response to the US Preventive Services Task Force review. J Clin Oncol. 2012;30(21):2581–4. doi: 10.1200/JCO.2011.40.4327.
Hayes JH, Barry MJ. Screening for prostate cancer with the prostate-specific antigen test: a review of current evidence. JAMA. 2014;311(11):1143–9. doi: 10.1001/jama.2014.2085
Cornford P, Van den Bergh RCN, Briers E, Van den Broeck T, Brunckhorst O, Darraugh J, et al. EAU-EANM-ESTRO-ESUR-ISUP-SIOG guidelines on prostate cancer—2024 update. Part I: screening, diagnosis, and local treatment with curative intent. Eur Urol. 2024;86(2):148–63. doi: 10.1016/j.eururo.2024.03.027
Wilt TJ, Scardino PT, Carlsson SV, Basch E. Prostate-specific antigen screening in prostate cancer: perspectives on the evidence. J Natl Cancer Inst. 2014;106(3):dju010. doi: 10.1093/jnci/dju010
Schroder FH, Hugosson J, Roobol MJ, Tammela TLJ, Ciatto S, Nelen V, et al. Screening and prostate-cancer mortality in a randomized european study. N Engl J Med. 2009;360(13):1320–8. doi: 10.1056/NEJMoa0810084.
US Preventive Services Task Force; Grossman DC, Curry SJ, Owens DK, Bibbins-Domingo K, Caughey AB, Davidson KW, et al. Screening for prostate cancer: US Preventive Services Task Force recommendation statement. JAMA. 2018;319(18):1901–13. doi: 10.1001/jama.2018.3710.
Lilja H, Ulmert D, Vickers AJ. Prostate-specific antigen and prostate cancer: prediction, detection and monitoring. Nat Rev Cancer. 2008;8(4):268–78. doi: 10.1038/nrc2351.
Thompson IM, Ankerst DP, Chi C, Lucia MS, Goodman PJ, Crowley JJ, et al. Operating characteristics of prostate-specific antigen in men with an initial PSA level of 3.0 ng/mL or lower. JAMA. 2005;294(1):66–70. doi: 10.1001/jama.294.1.66.
Loeb S. Evidence-based versus personalized prostate cancer screening: using baseline prostate-specific antigen measurements to individualize screening. J Clin Oncol. 2016;34(23):2684–6. doi: 10.1200/JCO.2016.68.2138.
Guo Y, Dong X, Mao S, Yang F, Wang R, Ma W, et al. Causes of death after prostate cancer diagnosis: a population-based study. Oxid Med Cell Longev. 2022;2022(1):8145173. doi: 10.1155/2022/8145173.
Hamdy FC, Donovan JL, Lane JA, Mason M, Metcalfe C, Holding P, et al. 10-Year outcomes after monitoring, surgery, or radiotherapy for localized prostate cancer. N Engl J Med. 2016;375(15):1415–24. doi: 10.1056/NEJMoa1606220.
Eklund M, Jaderling F, Discacciati A, Bergman M, Annerstedt M, Aly M, et al. MRI-targeted or standard biopsy in prostate cancer screening. N Engl J Med. 2021;385(10):908–20. doi: 10.1056/NEJMoa2100852.
Draisma G, Etzioni R, Tsodikov A, Mariotto A, Wever E, Gulati R, et al. Lead time and overdiagnosis in prostate-specific antigen screening: importance of methods and context. J Natl Cancer Inst. 2009;101(6):374–83. doi: 10.1093/jnci/djp001
Donovan JL, Hamdy FC, Lane JA, Mason M, Metcalfe C, Walsh E, et al. Patient-reported outcomes after monitoring, surgery, or radiotherapy for prostate cancer. N Engl J Med. 2016;375(15):1425–37. doi: 10.1056/NEJMoa1606221.
Loeb S, Bruinsma SM, Nicholson J, Briganti A, Pickles T, Kakehi Y, et al. Active surveillance for prostate cancer: a systematic review of clinico-pathologic variables and biomarkers for risk stratification. Eur Urol. 2015;67(4):619–26. doi: 10.1016/j.eururo.2014.10.010.
Andriole GL, Crawford ED, Grubb RL, Buys SS, Chia D, Church TR, et al. Prostate cancer screening in the randomized prostate, lung, colorectal, and ovarian cancer screening trial: mortality results after 13 years of follow-up. J Natl Cancer Inst. 2012;104(2):125–32. doi: 10.1093/jnci/djr500.
Pinsky PF, Prorok PC, Kramer BS. Prostate cancer screening — a perspective on the current state of the evidence. N Engl J Med. 2017;376(13):1285–9. doi: 10.1056/NEJMsb1616281.
Volk RJ, Spann SJ, Cass AR, Hawley ST. Patient education for informed decision making about prostate cancer screening: a randomized controlled trial with 1-year follow-up. Ann Fam Med. 2003;1(1):22–8. doi: 10.1370/afm.7.
Heijnsdijk EAM, Carvalho TM de, Auvinen A, Zappa M, Nelen V, Kwiatkowski M, et al. Cost-effectiveness of prostate cancer screening: a simulation study based on ERSPC data. J Natl Cancer Inst. 2015;107(1):dju366. doi: 10.1093/jnci/dju366.
Shteynshlyuger A, Andriole GL. Cost-effectiveness of prostate specific antigen screening in the United States: extrapolating from the european study of screening for prostate cancer. J Urol. 2011;185(3):828–32. doi: 10.1016/j.juro.2010.10.079.
Klotz L. Prostate cancer overdiagnosis and overtreatment. Curr Opin Endocrinol Diabetes Obes. 2013;20(3):204–9. doi: 10.1097/MED.0b013e328360332a.
Lillard JW, Moses KA, Mahal BA, George DJ. Racial disparities in black men with prostate cancer: a literature review. Cancer. 2022;128(21):3787–95. doi: 10.1002/cncr.34433.
Schaeffer E, Srinivas S, Antonarakis ES, Armstrong AJ, Bekelman JE, Cheng H, et al. NCCN guidelines insights: prostate cancer, version 1.2021: featured updates to the NCCN guidelines. J Natl Compr Cancer Netw. 2021;19(2):134–43. doi: 10.6004/jnccn.2021.0008.
Bell N, Gorber SC, Shane A, Joffres M, Singh H, Dickinson J, et al. Recommendations on screening for prostate cancer with the prostate-specific antigen test. CMAJ. 2014;186(16):1225–34. doi: 10.1503/cmaj.140703.
Dasgupta P, Davis J, Hughes S. NICE guidelines on prostate cancer 2019. BJU Int. 2019;124(1):1. doi: 10.1111/bju.14815.
Stephan C. Prostate cancer: WHO standardization of PSA tests: clinical consequences. Nat Rev Urol. 2009;6(6):303–5. doi: 10.1038/nrurol.2009.94.
Schroder FH, Hugosson J, Roobol MJ, Tammela TLJ, Zappa M, Nelen V, et al. The European randomized study of screening for prostate cancer–prostate cancer mortality at 13 years of follow-up. Lancet 2014;384(9959):2027–35. doi: 10.1016/S0140-6736(14)60525-0.
Gohagan JK, Prorok PC, Hayes RB, Kramer BS. The prostate, lung, colorectal and ovarian (PLCO) cancer screening trial of the National Cancer Institute: history, organization, and status. Controlled Clin Trials. 2000;21(6):251S–72S. doi: 10.1016/s0197-2456(00)00097-0.
Ferro M, Bruzzese D, Perdona S, Marino A, Mazzarella C, Peruolo G, et al. Prostate health index (Phi) and prostate cancer antigen 3 (PCA3) significantly improve prostate cancer detection at initial biopsy in a total PSA range of 2–10 ng/ml. PLoS One. 2013;8(7):e67687. doi: 10.1371/journal.pone.0067687.
Voigt JD, Dong Y, Linder V, Zappala S. Use of the 4Kscore test to predict the risk of aggressive prostate cancer prior to prostate biopsy: overall cost savings and improved quality of care to the us healthcare system. Rev Urol. 2017;19(1):1–10. PMID: 28522924.
Unduhan
Diterbitkan
Cara Mengutip
Terbitan
Bagian
Lisensi
Hak Cipta (c) 2026 Ilham Saptia Nugraha
Artikel ini berlisensi Creative Commons Attribution-NonCommercial 4.0 International License.
