After the introduction of the prostate specific antigen (PSA) test in the 1980s, a sharp increase in the incidence rate of prostate cancer was seen in the United States. The age-specific incidence patterns exhibited remarkable shifts to younger ages, and declining rates were observed at old ages. Similar trends were seen in Norway. We investigate whether these features could, in combination with PSA testing, be explained by a varying degree of susceptibility to prostate cancer in the populations. We analyzed incidence data from the United States' Surveillance, Epidemiology, and End Results program for 1973-2010, comprising 511,027 prostate cancers in men ≥40 years old, and Norwegian national incidence data for 1953-2011, comprising 113,837 prostate cancers in men ≥50 years old. We developed a frailty model where only a proportion of the population could develop prostate cancer, and where the increased risk of diagnosis due to the massive use of PSA testing was modelled by encompassing this heterogeneity in risk. The frailty model fits the observed data well, and captures the changing age-specific incidence patterns across birth cohorts. The susceptible proportion of men is [Formula: see text] in the United States and [Formula: see text] in Norway. Cumulative incidence rates at old age are unchanged across birth cohort exposed to PSA testing at younger and younger ages. The peaking cohort-specific age-incidence curves of prostate cancer may be explained by the underlying heterogeneity in prostate cancer risk. The introduction of the PSA test has led to a larger number of diagnosed men. However, no more cases are being diagnosed in total in birth cohorts exposed to the PSA era at younger and younger ages, even though they are diagnosed at younger ages. Together with the earlier peak in the age-incidence curves for younger cohorts, and the strong familial association of the cancer, this constitutes convincing evidence that the PSA test has led to a higher proportion, and an earlier timing, of diagnoses in a limited pool of susceptible individuals.

中文翻译：

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前列腺癌的前列腺特异性抗原检测：消耗有限的易感人群吗？

在1980年代引入前列腺特异性抗原（PSA）测试后，在美国发现前列腺癌的发病率急剧上升。特定年龄段的发病率模式向年轻人显示出显着变化，并且在老年人中观察到发病率下降。在挪威也看到了类似的趋势。我们调查这些特征是否可以与PSA测试结合使用，以不同程度的人群对前列腺癌的敏感性来解释。我们分析了来自美国监测，流行病学和最终结果计划的1973-2010年发病率数据，其中包括≥40岁男性的511,027例前列腺癌，以及1953-2011年挪威全国发病率数据，其中包括≥男性的113,837例前列腺癌50岁。我们建立了一个脆弱的模型，其中只有一小部分人会发展成前列腺癌，并且通过包含这种风险的异质性来模拟由于大量使用PSA测试而增加的诊断风险。脆弱的模型很好地拟合了观察到的数据，并捕获了整个出生队列中不断变化的针对特定年龄的发病模式。男性的易感比例在美国为[公式：参见文字]，在挪威为[公式：参见文字]。在越来越年轻的年龄段接受PSA测试的出生队列中，老年人的累积发病率没有变化。前列腺癌的最高队列特定年龄发生曲线可以由前列腺癌风险中潜在的异质性解释。PSA测试的引入导致了更多的被诊断男性。然而，即使在年龄较小的年龄段中，也没有更多的病例被诊断为处于PSA时代的出生队列。再加上年轻人群的年龄发病曲线更早达到峰值，以及癌症与家族的强烈关联，就构成了令人信服的证据，表明PSA测试在有限的人群中导致了更高的诊断比例和更早的诊断时间易感人群。