PSA 32)

*

(Evidence-based Medicine: EBM). STS EBM

,

(Prostate-specific Antigen: PSA) . EBM PSA

, �‘ �’EBM

�‘ �’ . , EBM PSA

EBM.

EBM EBM

.

(EBM), (PSA), , , (Medicine in Practice)

, , , , .

. * : sisyphus.gg@gmail.com

㕛㓠G ⚯ᠣⰋఛ⚯G ୗ⛼G ⿇G ᰗ㖫G ୗ☋G 㒯ᇫG 'ே⡨≃⚯㒰(Evidence-based

medicine: ⛋㒯GEBM⚓ឳGⳬⓔ)'⚯G㖬 ⛋ሻ. EBM⚗G⛨♛G⟇ೇG╇ೃᣓG∻∳㒯ேGⳬ❘፳G⚯㒰❘Gషᐻ┧G㒳Gᦫ〗⁴⚛GⅯ㓠㒯ᇫG⛨├GᑈG୰⛋GⰋఛ❘⛏G╇ೃఇᣓGㄌ㓋G┒┋⤛G㒰❘GேᣓG⚓ឳG㉧ሿ⛧ୗG⛧∷⚯G⚯㒰❘G㉧ሿ⚛Gௗヷ㒯ᇫG㓠♛ឳG❬⚯፳ሻ(⛋ᶛᐳG , 2004). 㕛✃GEBM⚛G⚯ᠣఛG❛Ⰻ┧G㖬 ∳⿻ᇫG☋ጰ⛋G❛G♛❘⛏G⭿☧┧Gᯣ┋⤗షG⛟ᇫ,

⛋ᇫG ⛛‘⤛ᠣ┧G ⚯ ⚯G ⤛ሿ⚛G ㎳⡗㖫∳⿻ᇫG ⛋ሻ(Timmermans,

2010). ╘ Gೄୗ┧GEBM⚗Gோ⚯ᠣ⚯G⡨≃Gቋ⚓ឳG⛧ᤃG⛸⒯ష, 㒳ೄ┧ጛG⚯ᠣఛ▗G❬┧G⚯㓋G⛋ᣓG❬⮀∳⿻ᇫG⛋Gఛ⃤፯షG⛟ሻ(㔟⁴, 2009).

EBM⛋G❳⒟㒯ᇫG㒰❘Gே⚯G♛ఛ❘G┧GᒇᛓG㈐❬㒳G⚯ᠣඇⅷᐻ⚯G ☀G᭦G⛼G╃ୗG㉧ሿ፯ᇫ,1) ൏┧GᒇᛓG ☀⛋Gே፳G ភୗG❛ᤔ⁷G㈐⛋㓄☧(Prostate-specific antigen: PSA) ௗ ⛋ሻ. 2011ႛG 10☫Gೄ⤟ᰨ╟ᤃᱏ (US Preventive Services Task Force)ᇫGEBM⚯G㒰❘Gே⚯G♛ఛ❘G┧Gඇ㒳G㌠ୗGఇG㕛✃G❛ᤔ⁷⒫G⟇ඇ⤛ሿ┧G ☀፯ᇫGPSA ௗ ⚯G♷㗿₈⚛Gః㒯⤗Gᨒ㓟ష, ⛋⛋G "㒳Gᶛ☀Gᛯ▗G㒛◫㒳G‴ௗ⚛Gည⚛GἧᤣG⒛ሟᛓ, ≃⤗┋G‴ௗG⛨☀┧G⚯㒳G ᤴᢷ⚛G⣴∳ሻ"ᧇG PSA ௗ ᣓG❛ᤔ⁷⒫GG⤛ᠣ⤗⚯Gషᛗ┧G❳ே㒯ඇᣓG◫Ⰴ㒯ᇫG �‘ᶛⳫ⯳Gᑈൠ�’⚓ឳG୬ᑈ∳⺇ሻ(Lin, 2011; USPSTF, 2011). ⛋▗Gካ┋G PSA ௗ ᣓGඇ㒯ᇫG⛓⛋G

1) EBM (Mcmaster University) (Gordon H. Guyatt)

(Guyatt et al., 1995). (1) (2) (3) , (4) - , (5) , (6) .

. 3 .

EBM┧Gே㒳G▊⚗G⟇╗⚓G⤗ൟඣ⤗Gᶛᄿඇ⚯▗G❳ⓔ㗣 ᐻ⚯Gൟ❛❘G⛋㓋ఛ┧GᒇᣏGឳ Gɒᒣ┧G❳ឳG∳㓠፯⤗Gᨒ㓟ሻᇫGᨀ⃣ᤃୗG⸻⤗ඇG∳⛨㓟ሻ.

⛓⭤⛋G<╘ೄ⚯㒰❗ၧ>(British Medical Journal)┧GYamey & Wilkes(2002)ᇫ ╘ೄ┧G EBM┧G ඇ㒳G ⚯ᠣඇⅷ╘㓼㌠ୗ(Health Technology Assessment)┧G ᒇᛓG⛋G൏G㒰❘G☀₈G♛㔯₈⛋Gᐳᝃဃ⚣┧ጛGೃ㒯షGPSA ௗ ୗGೄ┧G❛ᤔ⁷⒫G⟇ඇ⤛ሿGጛೃឳG╃❛㛟G ☀፯ᇫG⚗G♷㒯షG୬㒳GPSA

▐㖏⛧ᐻ⚯Gឳ Gɒᒣ⛋ᛓషG⡓⛼㓟ሻ. ⛋ᐻ⛋Gඇ┧ᇫG PSA ௗ ᣓG⤗⤗㒯ᇫG㖯⛧ሿⰋᐻG⟇⭿ጛG❳ⓔ㗣 ᐻ⚯G⤗☧⚛GᇫG⤨ሿ⛋┟ሻ. Zietman(2009)

⚗G EBM┧GᶛⴇG᱓GᒣG PSA⚯G♷☀₈⚛G⡓⛼㒷ᤣ㒳GேୗG㛃㒳G‘㗀┧Gఔ❳❘G⛋㓋ఛ┧G㙯Gሻ⤛ሿ⛋G⛋ᡛ➏▫ሻᧇ, ⚯ ᐻ⛋G⛋ᝃ㒳G⛋㓋ఛឳょGᓿ┋➏GEBM┧Gඇ㒳GௗヷGఇᣓGఏ㔟㛟G⒛ᐻ⛋ᇫG 'ⓨ≃-⡨≃G⚯㒰(conscience-based medicine)'⚛GⅯ㓠㓋ⓓG㒳ሻషG㓟ሻ. Milian(2012)⚯G┏⚗GⲳGၧᤃG㊔ᮇ㒳GPSA┧G㒳Gᶛ㉧❘⛏G∳⚛Gୗ⛼G⛯G╃⡓ᇫ, ൏႗ᇫG㕛✃G PSA ௗ ⚯G ☀G╃ᣓGᎯᝃ≏షG⛋ᡛ⤗ᇫGდ✘⚛GEBMG '⛓㖫❘G⚯㒰(anecdotal medicine)'  ⛋⚯Gఇ⛋ᛓషGᶛ⒯ሻ. ⛋G PSA ௗ ୗG '㒰❘'⚓ឳG♷㗿㒯⤗G⒡ሻᇫG❧⛋GEBM┧Gඇ㒳G╇ೃᐻ⚛Gㄌ㓋G⛜⣴፯┟⚣┧ጛGೃ㒯ష, PSA ⤗⤗⛧ᐻ⚗G ❛ᤔ⁷⒫⚓ឳG షㄌ⚛G ఁ⚛G ⅯጛG ⛟ኯG  ᛣ⛋GPSA ௗ Gኬ┧G‟ឳ☋G‍⚛G┒G፯┟ሻᇫG㒳ᎧGୗ⤗G⛓㖫ᐻ⚛Gୗ⤗షGௗ ⚯G♷㗿₈┧G㓋G '୧❬❘'⚓ឳG㖏⃣㒳ሻᇫG⛋ሻ.

⛋ᝃ㒳G⡓⛼ᐻGᏻ┧ᇫGEBM⛋G❳⒟㒯ᇫG㒰❘GேG♛ఛୗG㖬షጰ㒯షGఃష㒯G㒰❘⚓ឳG▃ᣏG⚯ ఇ❬ᤣ⚛GୗᤃሻᇫGୗ❬⛋Gණ⛟ሻ.2) ⛋GೃጛG⃤┧, PSA ௗ ᣓG⤗⤗㒯ᇫGೄGᶛᄿඇ㒰㗣G╃〗G⛛‘⚯ᐻ⚗Gᮈ㒳G㒰❘G⣴ேᣓGே㒯షG᧿ᎧGఔ❳❘G⛋㓋ఛG᧞᧞G₈ ភ┧G⯳⮀

2) , EBMPSA

(e.g. Amstrong & Eborall, 2012; Faulkner, 2009, 2012).

㒯ᇫGᑈGᶛ㒰❘⛋షG 㗣❘⛏G◫⃣┧G㙯ᎯᤃᇫG ᛣᐻឳGᩯ ፳ሻ.

PSA ௗ G♷☀₈Gდ✘┧G╇ᠿ፳G㓠♛⛧ᐻGୗ☋G⛓ୗG⡓⛼㒯ᇫGឳGೄ⚯GPSA ▐㖏⛧ᐻ⛋Gൟ❛❘G⛋ᐴ⚛G┒ඇG♛㓋G▃ᣏG㒰┧Gᅟ⚛GୗតሻᇫG⛋㓋ఛG⡨≃G⁴(interest-based analysis)⚛Gⴿ㒯ᇫG∷, ⛋Gൗ⚗G㒰Gდ✘┧G╇ᠿ፳G㓠♛⛧ᐻG ∻, ୗᐻ┧G㓋G⁷㔯❘⛏G㉧ሿ⛋Gୗ❬⚛G⤗ⓨ㒳G⮛GᎯ⚛Gഷᑈ㒯GცషG㒓ᇫGⷄ❘⛏G❨⚛GⅯ㓠㒷G⛋ሻ. 㒰Gდ✘┧G㒳Gⷄ❘G❨⚗G㒰❘G ∻⚛G⁷㔯❘⚓ឳG⟋✃㒯ᇫG∻✃ୗG⒛ሟᛓGೃⰋ❘⛏G 㗣❘, ❬❘, 㖫❘GᛔG⃤┧G╃ᝃG㖓⟜❘G㓠♛⛧ᐻ⚯G㕨‘G〗㕨⚯GఇឳG⛔ᇫG〳ጛ⛋ሻ(Latour, 1987). ' 㗣❘'⛋G '㒰❘'⛋ᛓᇫGሿ┋ᇫG㓠♛⛧ᐻ⚯GఔఛG⛨├(boundary work)┧Gጰ☧፯ᇫG⛧☧ᐻឳ, 㕛‘┧G㒳G⁻⛋G⒛ሟᛓG⁻፯┋ⓓG㒷G⁴G‘⛋G፯┋ⓓG㒳ሻ(Gieryn, 1983; Latour &

Woolgar, 1986).

⛋Gൗ⚗Gೄ┧Gᯣ┋⤛GPSA ௗ Gდ✘┧G㒳Gⷄ❘G❨⚛Gㄌ㓋GEBM

⛋ᛓᇫG㒰₈⚯G㎳‘⛋GPSA ௗ Gდ✘G❬┧Gⓨ┧G᧿ᎧGጰ☧፯┟⚓ᧇ, ඇ∻G㗣⚯⡓⚯⛧ᐻ⛋G EBM⛋Gௗ ⚯G♷㗿₈┧G㒳G⛧∷ᐻ⚯G⛜⛼⚛G⤗⤗㒳ሻషG୬㒯G⡓⛼㒷GⅯG⛟┟ኯG⚗G㖯⛧⚯G‍⚯G⤟⛋ᛓᇫGୗୗG⚯ᠣఛ┧G‟ឳ⛋G⡨≃GィឳG‘㒯ᇫG╄ ❘Gᛔ┧G⚯㓋Gᤣᐻ┋⤛Gఇ⛛⚛G⛓G⛋ሻ. ⛋ᣓG⚓ឳ, ⛋Gൗ⚗GEBM⛋G㒰₈⚛G㎳‘㒯ᇫGఃష㒯షG㖬షጰ㒳G‘⛋ᛓඇሻᇫG㓠♛⛧ᐻ⚯G⚯ጛ┧GᒇᛓGሻⓨ㒯G㓋⁴Gୗᇼ㒯ష,

╄ ❘Gᛔ┧GᒇᛓG⛛┝⛋Gᰗ㖫㒯ᇫG �‘♷╇㒳�’ ⛛⚛G⡓⛼㒷G⛋ሻ. ᱏG╇ೃᇫGEBM⛋ᛓᇫG⤛ᠣ⚯G㎳⡗㖫G⛨├┧G㒳G❳G㒿⚯ᣓGEBM⛋G┞⛏⤗ᣓG⁷㔯❘⚓ឳG❬⚯㓋GცషG〧ೃ㒯ᇫGቋ❘, Ⳬ‘❘G⭿☧⚯G❨G∷, ∻❳ឳGEBM⚯G⛋ᣛ⚓ឳG⛋ᡛ⤗ᇫG∻㓠(practice)⚯G⭿☧⚛G㌋⛧ᇫGTimmermans

& Berg(2003: 21)⚯G❳⒟⚛Gᒇᣏሻ.3)

3) EBM (Evidence-based Practice, EBP)(Evidence-based Health care, EBHC), (Evidence-based Treatment, EBT)

.

PSAᇫG❛ᤔ⁷┧G‴₈፯┋G ❬G㘛G ⚨ష፳G❬Ⓒ⚛Gა⛋ᇫGඇᇼ⚛G㒯ᇫG㗿⃣ឳ, ❛ᤔ⁷⛋ᛓᇫG⛼ඇ┧ᤣGᤣᐻ┋⤗షG❛ᤔ⁷⒫⛋Gᰨ㒷Gఔ☇G㕟⡨GPSA ფጛୗG⣴ୗ㒳ሻᇫGః┧Gே㓋G₈⚯G❛ᤔ⁷⒫G⟇ඇ⤛ሿG❛ᤔ⁷GG⤟㖯⚯G╟㘛G⮇⛋ᛓᇫGᎧGୗ⤗G☀ጛ⚯Gௗ ឳG⛧ᤃG⛸⒯ሻ. PSA ௗ ▗G፳Gდ✘⚛Gௗヷ㒯ඇG♛㓋G㒛◫㒳G⛨├⚗G☇⁷GPSAୗG⛋G❛ᤔ⁷⒫G⟇ඇ⤛ሿG᭦GᰨඇG⮇Gௗ ឳG⛧ᤃ㒯ᇫG╄ ❘⛏G❬⚛GⳫ❘㒯ᇫG⛓⛋ሻ.

2. PSA ௗ ⚯G╄ ❘Gᮇఔ

1) ❛ᤔ⁷⒫G⮇G㎳⤗⛧ឳGPSA ௗ ⚯G㖬ᤔG

❛ㄌ❘⚓ឳG❛ᤔ⁷⒫⚗GೄG₈┧Gᰨ㒯ᇫG⒫ᐻGୗ☋Gୗ⛼G㚫㒳G⤟㖯⛋┟⚓ᧇ, ╃ᝃG⒫ᐻGୗ☋GᎧGᯟ⥏ឳGჩ⚗G ᤴᢷ⚛G╃G▫ሻ(Parker et al.,

1996; Brawley, 1997). ⛋ᝇG⛋♷Gᒣ┧G❛ᤔ⁷⒫⚗G╻ᜂጰ⒟GೄG⡨ோGቐೄG NIH(National Institutes of Health), NCI(National Cancer Institute),

ACS(American Cancer Society), AUA(American Urology Association) ᑈGೄ⚯G⚯ᠣG❛ୗᐻ┧G⡨◫㒳G≃G‘⛋┟ሻ.

2⭿G❛G❛㘛┧Gೄ⚯G⒫G╇ೃG⤗㕬ጛᇫGൠ㒯Gᰗ㖫㓟ሻ. 1913ႛG⁻ᤔ፳GASCC(American Society for the Control of Cancer)ୗG 1944-1945ႛG ⛋GACSឳG‟ឳ⛋G⟇⤘፯┟ష, ╇G╟ ⛋G 2ႛG ⛋┧GⓔG 10ᤣGቃᝃ┧G 400ᤣGቃᝃឳGൠ⣴㓟ሻ. ⛋G୰⚗G㏤㒳G⛧☧⚛G⚓ឳGACSᇫGேG❘⚗G╟ ⚓ឳGⅯ㓠

, ,

EBM

.

㒯ኯG⒫G╟ G☋ጰ┧G❘❘⛏G⒫GᠣឳG㕨㗣⚯G㓼Gᨀ❘⚛G❛㖯㒯╗ష, NCI ╄∳G⒫⚛G⟇ඇ┧G⤛ሿ㒯╃Gᠣ㒳ሻᇫG⚛Gⲳ☇⁷⚯Gᨀ❘⚓ឳG⁻❬㒯╗ሻ. ⛋G⒫⚯G╟┧G〧⤗G᭦GᠣឳG㓼⛋G❛㖯፯G൏ᐻ⚯Gㆃ⛧Gᕧ㒳G╟ G㖤G㖳ጰ┧G⒫⚛G〧⤗㒷GⅯG⛟ᇫG⤛ሿGௗ ᐻ⚯G୳ឳG▅➣ሻ. ⛧ఔ⒫⚯G⟇ඇ⤛ሿGௗ ឳG㕛✃ඣ⤗G ☀፯షG⛟ᇫG㊐Gィ⇻㈏(Pap smear test)ᇫGACS▗GNCI ᑈ⚯G⛋ᝃ㒳G⤗☧⛋Gᤵ᪓ᤃGᑈ⛼㒳G ᪓⛋┟ሻ(Casper & Clarke, 1998). AUAᣓG㍃㒿㒳G❛ᤔ⁷⒫G╇ೃ⛧ᐻ⚗G⛋ᝃ㒳G‘㗀G⃤┧G⛧ఔ⒫Gௗ ▗G୰⚗G"₈☀G㊐Gィ⇻㈏(male Pap test)"ᣓG୳㒯ඇG♛㓋G⭿ᣓGୗ㓟ሻ(㉿㈏ᤄG☫∳·⛧ႎG☣㉜る, 2010: 164).

⛓⭤⛋G 1930ႛG ⡨ G ⚯㒰⛧ᐻ⚗G ❛ᤔ⁷ ⛏ 㗿⃣(Prostatic acid

Phosphatase: PAP)⚯GფጛୗG❛ᤔ⁷⒫⛋G❛⛋፳Gṟ┧G⣴ୗ㒳ሻᇫG ∻⚛Gః㒯ష, PAPᣓG❛ᤔ⁷⒫G⤛ሿG᭦G⮇G㎳⤗⛧ឳG ☀㒯ඏG⡓⛼㒯╗ሻ(Burgess

& Evans, 1949). ⛋ᐻ⚗GPAP ௗ (test)ୗG❛ᤔ⁷⒫⚯G"㊐Gィ⇻㈏(Pap test)"ୗG፯ඇᣓGඇ㒯షG⛋G㎳⤗⛧ᣓGሻᑃඇG♛㒳G╇ೃᐻ⚛GⅯ㓠㒯╗⚓, ❛ᤔ⁷G⟇⤘┧G㒳G㈐⛋ጛ(specificity)ୗGစሻᇫG❳Gᒣ┧G㒳ఛ┧Gᒁ㕫ሻ.4) PAPᇫG❛ᤔ⁷G⟇⤘G●┧GሻᣏG⛼ඇᐻG❬‘❘⛏G‘〳⚯G㕟Ⰴ┧ጛG〗GἧᤣG⒛ሟᛓG ♷⒫G ᭦G ሻᣏG ⛼ඇ⚯G ᶛ⣴┧ጛG ‘∐㒯ᇫG ఔ㓼⚛G ⤗ႫඇG ᒣ┧,

PAPឳG❛ᤔ⁷⒫⛋G⤛ሿ፳G㖯⛧ᐻGୗ☋G⛋G♛ⓨ₈(false positive) ⚨⚓ឳGఇ⤗┋⤗G㓟ሻ(Crawford & Waxman, 2001). ⛋⯯ G PAPୗGᮈ㒳G㒳ఛᣓG⛋ᇫG‘㗀G⃤┧, ⚯㒰⛧ᐻ⚗GACS ⚯G "᧿ᐷG⤛ᠣ⃣ᇫG⒫G⤛ሿGₓょ"

ᛓᇫG∃ឳோ⚛Gⴀ∻㛟GⅯ㓠㒯ඇG♛㓋G⛋ᣓGⰋ㒷ᤣ㒳G⤛ሿGௗ ᣓG᧿†㒯ᇫGᨇᎧ㓟ሻ(Ross, 1987).

4) (sensitivity) (specificity).

, .

, .

1970ႛ┧Gᐻ┋G⚯Gఇ∻⛋Gᥑ┋⤗ᇫGᑆ⛋G╗ሻ. ⛋G∳ඇ┧G୧G㑛ឳ㉋(쩂-Seminoprotein), E1-㓄☧, P30 ᑈG୰⚗GⅯᤥ⚗G❛ᤔ⁷G᭦G❬ⒸG ㈐❬❘G 㓄☧ᐻ⛋G ః፯┟ሻ. ⛋G ᛔG ⃤┧G 1979ႛG Roswell Park

Memorial Institute⚯GWang ᑈG⚗G❛ᤔ⁷G⟇⤘G❬Ⓒ┧G㈐❬㒳G㓄☧⚛Gᤃ㓋ဋషG ⛋┧G ❛ᤔ⁷㈐⛋㓄☧(PSA)ᛓᇫG ⛋ᣛ⚛G ᳰ╗⚓ᧇ, 1980ႛG ▬(Wang)⚯G╇ೃ⃣GጰᠣୗG⡓ጛ㒳G╇ೃᇫGPSAୗG❛ᤔ⁷⒫G㖯⛧⚯G㕟⡨┧ጛGః፳ሻషGష㒯╗ሻ(Papsidero, 1980). 1990ႛG┧G⛋ᣋᝃG♛┧G┏ൠ㒳G᧿ᐷG⟜⚯G㓄☧ᐻ⛋G᧿ᎧGሿ⛓㒳G㒯⚯G∻✃, ⣠GPSA⛏G⚓ឳGఇ⤗┋➣ሻ. ൏ᝃG㕛✃⚯Gᛔ┧G⡨◫㒳G⚗G PSAୗG❛ᤔ⁷┧ᤣG‴ ፯ᇫG❛ᤔ⁷-㈐❬❘⛏G㓄☧⛓GἧᤣG⒛ሟᛓG❛ᤔ⁷⒫G㖯⛧┧Gః፯┟ሻᇫG ∻⛋ሻ.

ካGᤥ⚗G⚯㒰⛧ᐻ⛋GPSAୗGPAPᣓG∷㒷GⅯG⛟ሻᇫGୗᇼ₈⚛GషG╇ೃ┧Gᙇ┋ᐻ┟ሻ. ╇ೃ⛧ᐻ⚯GⰂG⛨├⚗GPSAᣓG〧⤗㒯ඇ┧GሻG☀⛋㒳G❬ ᯬ⚛G᧿†㒯ᇫG⛋┟ሻ. ඇ⟋┧G ☀፯ኯG╄❛ඇ╘ጰᯬ(immunoelectrophoresis)⚗ 㒳Gⓨ⚯GPSAᣓG㍃⮀㒯⤗Gᨒ㒯ᇫGሿ❧⚛G⤗Ⴋሻ. ឳ⇻♇㉣⿃GඇႧ╇ೃ⃣⚯G╇ೃ⛧G▬⚯Gጰᠣ⛏GKuriyamaᇫG 1980ႛG  ⁷╄❬ᯬ(radioimmunoassay: RIA)⚛G ☀㒯╃G㘿⒃G❘⚗Gⓨ⚯G PSA ᕧ㒳Gௗⳳ㒷GⅯG⛟⚣⚛G╗ష,5) 1981ႛG▬G⼷ᤃⓓ(Kuriyama), ൏ᤃషG൏ᐻ⚯Gጰᠣᐻ⚗G RIAᣓG ☀㒯╃G PSA⚯GⅯᣓG〧ೃ㒯ᇫG⛨├⛋G❛ᤔ⁷⒫G㖯⛧⚯GᰨඇᣓG⮇㒯ᇫGG ☀፷GⅯG⛟ሻషG⡓⛼㓟ሻ. ⛋㘛G1984ႛGPSA┧G㒳Gⲳ⚯G‘├❘GRIAୗG㒯⛋ᵣᤃイ紹┧G⚯㓋Gⳳ∳፯┟⚓ᧇ, ୰⚗G㓋GⓨGᯛヷᤃ紹┧GPros-Check PSAୗG୳፯GPSAᣓG❛ᤔ⁷⒫G㎳⤗⛧ឳGᤣᐻᇫG╇ೃୗGୗ⃤㖫፯┟ሻ. 1986ႛGG∴ⓔⰄ(FDA)⛋GPSAᣓG❛ᤔ⁷⒫G '⮇' ᭦GᤃGጛೃឳG∐⛏㒳G⛓⚗Gቐ⚯G╇ೃ⛧ᐻ⚯G PSAᣓGᶛᄿඇ㒰❘G ∻㓠⚓ឳG ጛ⛜㒯ᇫG ⛨├⛋G ∷⚛G ┒ᇫG ఛඇୗG ፯┟ሻ(Pienta,

2009).

FDA⚯G∐⛏G⛋ᛯ, PSA⚯G❛ᤔ⁷⒫G⮇G᭦GᤃGጛೃឳ⚯G♛ᇫGካ☈G

5) 500ng/mL PSA , 0.01ng/mL PSA .

〛⚛GషG୬㖫፯┟ሻ. 1980ႛG‟ឳ⛋Gᑈ⛼㒳G❛ᤔ⁷⒫GᠣGᯬ⛏G❘G❛ᤔ⁷G❟❳ⅷ⚯G╟㘛ᣓG⤛ሿ㒯ᇫGG PSAୗG♷☀㒯ᧇ(Langer et al., 1989),

PAPሻG❛ᤔ⁷⒫⚛G⮇㒯ᇫGG⛟┋G☫ᑈ㒳Gᇼ⚛G⛏ሻᇫG╇ೃୗGష፯┟ሻ(Stamey, 1987). ⛋㘛G PSAᇫG 1966ႛG⛋ᛯG❛ᤔ⁷⒫⚯GᰨඇᣓG㖬⛏㒷GᒣG ☀፯┋G╻ኯGൗᤃ⇿G❧Ⅿ(Gleason score)▗Gఇ㓀㒯╃GᠣG㘛G❛ᤔ⁷⒫⚯G‘〳ᣓG╟㒯షGᰨඇᣓG㖬⛏㒯ᇫG⮇G㖳ጰ⚯G㓌≃GጛೃឳG⛧ᤃG⛸⒯ሻ.6)

❛ᤔ⁷⒫GᰨඇG⮇Gௗ GጛೃឳG PSAᇫG❛GఛGᰨ☧⚯GᶛᄿඇG⤛ᠣ∻G ௗ ∻, ൏ᤃషG ∻㔯∻ឳG 㖬 ፯┟ሻ. Ⅿᤥ⚗G ᶛᄿඇ⚯ᐻ⚗G ⛋GPSAୗGᶛᄿඇ㒰❘G∻㓠┧G ₈❘⚓ឳG ⤛⛜㒳G⛋㘛ᣓG �“PSA⚯G∳(Era of

PSA)�”ᛓషGᣋᧇG൏ᐻ⚯G⛓❘⛏G㖳ጰG⛨├⛋Gᱏ❘⚓ឳGᰗ㖫㓟ሻషG⡓⛼㓟ሻ(Etzioni et al., 2009). ⛋G❛ᤔ⁷⒫G⮇Gௗ ឳGᶛᄿඇ㒰❘G∻㓠┧Gㆃ㒯G፯, PSAᇫG PAP▗GቃᤃG⟇ඇ⤛ሿGௗ ឳG⛧ᤃG⛸⚛Gඇ㗣ᣓG⢧G፳Gᑆ⛋G╗ሻ.

2) PSA ௗ G╘╄⚯G㖬⛼: ❛ᤔ⁷⒫G⮇G㎳⤗⛧┧G⟇ඇ⤛ሿGጛೃឳ

൏ᝃG1986ႛGFDAୗG❛ᤔ⁷⒫G⮇G㎳⤗⛧ឳG∐⛏㓟⚣┧ጛGೃ㒯షGPSAᇫG⣠∳G⛧ఔ⒫⚯G㊐Gィ⇻㈏▗G୰⚗G❛ᤔ⁷⒫G⟇ඇ⤛ሿGௗ GጛೃୗG፷GⅯG┝┟ሻ. ❛㘛GACS▗GNCI⚯G❛㍄❘⛏G⤗☧G⃤┧G PAPୗG '₈G㊐Gィ⇻㈏'ឳG൏G∻㗿₈┧Gᶛ㓋G⤗G⛼G㖤፳G⛓⚛Gఁ┋╿G⛓ G⛛‘⚯ᐻ⚗GPSAᣓG⟇ඇ⤛ሿGௗ ឳGᇫG❧┧G❗㓄㓟ሻ. ሻୗ, ᶛ G PSAୗG PAP▗GቃᤃG❛ᤔ⁷G㈐❬❘⛋⤗ᤣ, ❛ᤔ⁷⒫ἧᤣG⒛ሟᛓG❛ᤔ⁷ᶛ⣴G㖯⛧ᐻ┧ጛG PSA

ⅯୗG 4-10ng/mLඣ⤗G‘∐㒳ሻᇫG❧⛋Gష፯GᐳᝃGჩ⚗G♛ⓨ₈ᢷG

6) (Donald F. Gleason) , (grade)

, (score)

( · , 2010: 207-209)

စ⚗G㈐⛋ጛᇫG⛧╇⇻GPAP┧G㒳G㖯㖏▗GᏻᒇᣏG∻㉿⚯Gఔ㔯⚛GPSA┧G㒳G㕛✃⚯G㖯㖏▗Gᶛಧ㒯G㒯G㗣⚯❘⛏G♛ඇᣓG㕬₈㒯╗ሻ(De Angelis

et al., 2007: 115).

PSAᣓG⟇ඇ⤛ሿGௗ ឳG ☀㒯ᇫG⛓┧G㒳G㗣⚯❘⛏G♛ඇ┧ጛGೃ㒯ష, 1990-1993ႛGጰ⒟GAUA ⃣⃤⚯Gᶛᄿඇ⚯ᐻ, ൏ᤃషG⯯⚣⚓ឳG‘├☀GRIA

ᣓG୳㒳G㒯⛋ᵣᤃイ G୰⚗Gඇ├G⃣⃤⚯G╇ೃ⛧ᐻ⚗GPSAᣓG❛ᤔ⁷⒫G⟇ඇ⤛ሿGௗ ឳG⛨ጰGୗᇼ㒯GᤣᐻඇG♛㓋G㓟ሻ. ⛋ᐻ⚯G❛ᜌ⚗G⿃GGୗ⤗╗ᇫ, 㒯ᇫG❛ᤔ⁷⒫G㖯⛧▗G❬‘⛏⚛Gೃᰛ㒷GⅯG⛟ᇫG PSA ⅯᣓG⁻❬㒯ᇫG⛋┟ష, ሻᣏG㒯ᇫG⛋❛┧G⛋G⟋✃㒯ኯG❛ᤔ⁷⒫G⟇ඇ⤛ሿGௗ GⰋ❳┧G PSAୗG㍃㒿፯GᤣᐳᇫG⛨├⛋┟⚓ᧇ, ⤗⚓ឳGPSA ௗ ⚯G❳ឳG❳ඇ፯ᇫGჩ⚗G♛ⓨ₈ᢷGစ⚗G㈐⛋ጛᣓG㓋ఇ㒷G▛ඇⅷᐻ⚛G❛∳⿻ᇫG⛓⛋┟ሻ. 1984ႛG㒯⛋ᵣᤃイ ⚯G⤗☧⚛G⚗GMyrtle ᑈ⚗G❛ᤔ⁷⒫Gᰨ⛋G┝ᇫG 472⚛G‘⚓ឳGPSA ௗ ᣓGⅯ㓠㓟ష, ൏GఇG┒┋⤛G⛋ょᣓG⚓ឳG❛ᤔ⁷⒫GᰨG㖯⛧▗G❬‘⛏G ⛋ᣓGೃᰛ㒷G‘㒳G4.0ng/mLᣓG❳⒟㓟ሻ. ൏ᤃషG⛋┋G㒯⛋ᵣᤃイ ⚯G⤗☧⚛G⒯ኯG Catalona(1991)ᇫG 50-74

G ⛋⚯G₈ᐻ⚛G‘⚓ឳG㒳G6,630⚯G⤛ሿG╇ೃᣓG⚓ឳG4.0ng/mLୗG❛ᤔ⁷⒫G㖯⛧▗G❬‘⛏⚛Gೃᰛ㒯ඇ┧G❘❟㒳GⅯᛓషGష㒯╗ᇫ, ⛋G୰⚗Gⓨ㖫፳G‘㒳G⁻❬⚗GPAP▗GቃᤃGPSAୗG⟇ඇ⤛ሿGௗ ⚯Gඇᱏ❘⛏G⟇ோ⛏G⒫㖯⛧▗G⛓⛏⚛Gೃᰛ㒷GⅯG⛟ᇫG❬㖬㒳GⅯୗG⟋✃㒳ሻᇫG㖬∷⚛G୭G㓟ሻ(Hermandez & Canby-Hagino, 2009: 53).

⛋▗Gካ┋G╇ೃ⛧ᐻ⚗G PSA ௗ ୗGඇ⟋G⟇ඇ⤛ሿGௗ GጛೃᐻG㒿ฯG ☀፷Gఔ☇G㘿⒃Gჩ⚗G❛ᤔ⁷⒫G〧⤗♿⚛G⛏ሻషG⡓⛼㓟ሻ. ඇ⟋G⟇ඇ⤛ሿGௗ GጛೃឳᇫGㄌG⤘⛼Ⅿ⤗ௗ ୗG ☀፯┟ᇫ, ⛋ᇫG⛛‘⚯ୗG㖯⛧⚯G㓄┧Gୗᛔ⚛Gၺ┋G❛ᤔ⁷⒫⚛G⤛ሿ㒯ᇫGᯬ⚓ឳ, ጛឳGစ⚗G〧⤗♿G⚯ ⚯Gⅰጛ┧GᒇᛓG᭓୧ጛ▗G㈐⛋ጛୗGᰗ㒯ᇫG⡓❘⛏G₈⚛Gᚷ┟ሻ. 1990

ႛGCoonerᇫGPSA ௗ ୗG⤘⛼Ⅿ⤗ௗ G᭦G⤘⛼⚣㉣ௗ ▗Gఇ㓀㒯╃G ☀፷Gఔ☇G⟜ᛯGᯬ⚓ឳGௗ 㒯ᇫGሻG㘿⒃Gჩ⚗G〧⤗♿⚛G⛏ሻషG⡓⛼㓟ష,

⛋㘛⚯G╇ೃఇᐻ⛋G⛋ᣓG⤗⤗㓟ሻ(Cooner et al., 1990; Vessella & Lange, 1992).

1993ႛGACSᇫGPSAᣓG㍃㒿㒳G⟇ඇ⤛ሿGௗ ┧G㒳G⛧ⰋG㗿ᇼG╇ೃᣓGㄌ㓋G⛋G୰⚗G ఇ㓀⛋G ♷☀㒯ሻషG ఇ G ဋតሻ(Mettlin et al., 1993a). ⤗⚓ឳG 㕟⡨GPSA ფጛᣓG❬㒯ᇫGPSA ௗ ୗG୭ᇫG❳⛏Gစ⚗G㈐⛋ጛᣓG▛㒯ඇG♛㒳G⟇ඇⅷᐻ⛋G᧿†፯┟ష,7) ⛋┧GᒇᛓGPSA ௗ ⚯G♛ⓨ₈ᢷGစ⚗G㈐⛋ጛᇫG㓋ఇGୗᇼ㒳G❳⯯ G⛋G፯┟ሻ(Bunting, 2002: 75-78).

❛ᜌᐻ⚗G₈❘⛋┟ሻ. 1992ႛG11☫G7⛓┧G୳ⲳ፳G᧿⛛┧GACS ⛋ 㗣⚯G⛛☧ᐻ⚗G "50G⛋‘G₈ᐻ⚗G⤘⛼Ⅿ⤗ௗ ▗G㒿ฯGPSA ௗ ᣓG❛ᤔ⁷⒫G⟇ඇ⤛ሿGௗ ឳG⒛ⓓG㒳ሻ"షGⳫ⯳㓟⚓ᧇ, "4.0ng/mLᣓGඇ⡗ឳG ☀㒯ඇᣓ" ❳⒟㓟ሻ(Mettlin et al., 1993b: 44). FDA ᕧ㒳G 1994ႛG㒯⛋ᵣᤃイ ⚯G RIAᣓG ☀㒯╃Gጛⳳ፳G 4.0ng/mLᣓGඇ⡗ឳG⁻❬㒳G PSA ௗ ᣓG❛ᤔ⁷⒫⚯G⟇ඇG〧⤗ᣓG♛㒳G⤛ሿGௗ ឳG ☀㒷G⚛G∐⛏㓟ሻ(Henkel, 1994). FDA⚯G∴❘⛏G∐⛏┧GᒇᛓG❛ᤔ⁷⒫G⟇ඇGௗ⤛GጛೃឳG PSA ௗ ᇫG❳ጛ❘Gᐎ⚛GG፯┟ష, ⛋G୰⚗GⳫᇫGAUA▗GNCCN(the National Comprehensive Cancer

Network) ୰⚗G⤨ሿᐻ⛋GACS▗G♷ 㒯GPSAᣓGⳫ⯳㒯G୬㖫፯┟ሻ(Ferrini

& Wololf, 1998).

൏ᝃG❛ᤔ⁷⒫G⮇GጛೃឳG PSA ௗ ୗGᶛᄿඇ㒰❘G∻㓠ᐻ┧G₈❘⚓ឳG⒟⮀㒳GGቃᤃ, ⟇ඇ⤛ሿGௗ ឳ⚯G PSA ௗ ᇫG FDA⚯G❳ጛ❘G∐⛏⚛G⚗G൏Gቐ∳ょG㗣⚯⡓⚯❘G∳⚯G╇ೃ⛧ᐻG⚯ᠣG❛ୗG⤨ሿᐻ┧Gᶛ㉧⚛G⒯ᇫ, ⛋G∳ඇᇫGEBM ☋ጰ⛋GೃG⚯ᠣఛG❛┧G㖬 ፯ኯG∳ඇ▗Gᤵ᪓ᤇሻ(Timmermans & Berg, 2003: 13-18). EBM ∳⚯GጛᛯᛓᇫG‘㗀❘GᛔG⃤┧, ⟇ඇ⤛ሿGௗ ឳGPSAᣓG ☀㒯ඏG⡓⛼㒯ᇫG⛋ᐻG㗣⚯⡓⚯⛧ᐻG᧿ᎧG൏ᐻ⚯G⡓⛼⚯G❬ቐ₈⚛G┒ඇG♛㓋GEBM⚛Gጰ☧㓋ⓓᤣG㓟ሻ.

7) PSA (volume) , PSA PSA PSA (velocity) , PSA

(free PSA) (compound PSA)PSA (isoform) .

3. ♷╇㒳Gே⡨≃⚯㒰: PSA ௗ ⚯G㗿☀₈Gდ✘

ೄ⤟ᰨ╟ᤃᱏ (USPSTF)▗G ACP(American Colleges of Physicians) ୰⚗G⤨ሿᐻ⚗GFDA⚯G∐⛏⛋G⛋ᠿ┋⤛G1994ႛఔょGఛ⃤㓋GPSA ௗ ᣓG❛ᤔ⁷⒫G⟇ඇ⤛ሿGௗ ឳG ☀㒯ᇫGG⚯ೃ≃⚛G㎳㓟⚓ᧇ, ⛋G୰⚗G㗣⚯❘⛏G∳⚗G2000ႛGᐻ┋GAAFP(American Academy of Family Physicians) ୰⚗G〗G❛ୗG⤨ሿᐻឳG㖬 ፯┟ሻ(Zoorob et al., 2001). ⛋G‘㗀┧GACS, NCCN, AUA, ൏ᤃషG㒯⛋ᵣᤃイ G୰⚗Gඇ├⚯G㘛☧⚛GேG⃣⃤⛏G⛋ᐻ⚛Gᶛ㒳GPSA ╇ೃ⛧ᐻ⚗GPSA ௗ ᣓGFDA⚯G∐⛏⚛Gㄌ㓋G⟇ඇ⤛ሿGௗ ឳG❳ጛ❘G⛏⡗⚛G⚗G㘛G⛋ᣓG⒟❬㖫∳⿻ඇG♛㒳G❛G♛❘⛏G⚛G㌓ⰻሻ.

⛋ᝃ㒳GGୗ☋G㒯ୗGEBM⚛G☇ೇ⚓ឳGᤣᐳᇫG⛓⛋┟ሻ. ⛋G❟┧ᇫGPSA ௗ ᣓG❛ᤔ⁷⒫G⟇ඇ⤛ሿGጛೃឳGᤣᐻᇫG▐㖏⛧ᐻG⛋ᐻ⚛G㒯ᇫG㗣⚯⡓⚯⛧ᐻGⓨ⛋G EBM⚛Gㄌ㓋G‘ᣓGდ㒯㓟ኯG∳ጛᐻ⚛Gௗヷ㒳ሻ.

Brown & Webster(2004: 161-183)▗GFaulkner(2009: 27-41)ୗGㄌ❘⚓ឳG⤗❘㒯ᑆ⛋, 1990ႛG⡨ G⛋㘛G⚯ᠣඇⅷ┧G㒳G㌠ୗGⰋ❳ᇫGEBMG⛋┧Gඇ㒳G⚯ᠣඇⅷ╘㓼㌠ୗ(Health Technology Assessment)ឳG ✃❬ᶛ፯┟ሻ.8) 㕛㓠G ⰋఛG㒯┧G⚯ᠣඇඇ⚯G❘㓀₈G╃▗G⤛ᠣ⤗⚯GషGⅯ⡗⚗G㓋ቐG❳┧G㒳G⣴ேୗG㒰❘⚓ឳG┓G㖬ష㒳ୗ┧GᒇᛓG⁻❬፯ᇫ, ┋ᓻG⣴ேୗG㒰❘⚓ឳG┓G㖬ష㒳ୗᇫGEBM ╇ೃ⛧ᐻ⛋G❳∳㒳G⣴ேGⅯ⡗⚯G♛ఛ❘G┧G⚯㓋Gఇ❬፳ሻ.

8) 1989 Agency for health Care Policy & Research1999 Agency for Healthcare Research & Quality(AHRQ)EBM HTA .

<൏ᤓG 1>⚗Gௗ⤛⛋Gᠣ⚯G㗿┧G㒳G⣴ே⚯G♛ఛG⛋ሻ(Glover et

al., 2006). ⛋┧Gᒇᣋ, ❛ୗ⚯G୳⛏❘⛏G⃣ః⛋G୳ᰛG⣴ភGషᇫGୗ⛼Gစ⚗G Ⅿ⡗⚯G 㒰❘G ⣴ே⛋ሻ. ሻG ჩ⚗G Ⅿ⡗⚯G ⣴ேᇫG 㖯⛧-⟇ೇG ╇ೃ(case-controlled studies)▗G⺫㖏㈏G╇ೃ(cohort studies)ឳG┒┋⤛Gఇ⛋ᧇ, ൏ሻG‘♛┧G⃤㒳G⛋G⛨♛G⟇ೇG∳㔯⛋ష, ୗ⛼Gⲳ‘⚯G⛋G⛋G⛨♛G⟇ೇG∳㔯ᐻ⚯GఇᣓG⟜㓀❘⚓ឳG⁴㒳GⰋఛ❘G㔣ష⮇⛋ሻ. ⣴ភGషᇫGG൏ឳG㈐❬㒳G୳ᰛG㖯⛧┧GⅯ㓠㒳G⚯㒰❘G⯯⚯G❬GఇᣓG‘㛟Gⅷ㒳Gష⛋ሻ. ⺫㖏㈏G╇ೃᇫG㈐❬G⛏⛧┧Gⳳ፳G⛏ೃ⤨ሿ⚛G∳ఔ┧GᒇᛓGⳫ❘G⮇㒯╃G⤟ᰨG‴ᢷ┧G㓋Gⳳ፯⤗G⒡⚗Gㄌ❳⤨ሿGᶛಧ㒯ᇫG╄㒰❘G╇ೃᯬ⛋ሻ. ⛨♛G⟇ೇG∳㔯(RCTs)⚗G╇ೃ‘⛋G፯ᇫG⤨ሿ⚛G⛨♛ឳG⁷❬㒳G㘛, ⛋G⡨G㒳G⤨ሿ┧G╇ೃGᨀ❘⛋G፯ᇫGⓔ᪓G㖐⚗GᠣᣓG❳㒯షG൏G⤨ሿGᶛ፷GG⤨ሿ┧G♛ⓔ(placebo) ⯯ᣓG㒳G㘛G⛓❬GඇGⳫ❘⮇⚛Gㄌ㓋G൏G㗿ᣓGௗ 㒯ᇫGᯬ⛋ሻ. ╃ඇ┧Gᥐௗ(blindness)⛋G∻∳G፷Gఔ☇GካGჩ⚗G╇ೃG∷᠇ጛᣓG㖬㒷GⅯG⛟ᇫ, ┋ᓻG⤨ሿ┧G♛ⓔG㖐⚗GᠣG⯯ᣓGᮇ❬㓟ᇫ⤗ᣓG㌠ୗ⛧ୗG⒣Gఔ☇ᣓGሿ⛓ᥐௗ, ╇ೃ‘⛋G㌠ୗ

⛧G᧿ᎧୗG᧿ᣓGఔ☇ᣓG⛋⡨ᥐௗ⛋ᛓG㒳ሻ. Ⰻఛ❘G㔣ష⮇⚗Gള᧿G⛨♛G⟇ೇG∳㔯ᐻ⚛Gᶛ㒳G㒰❘G⣴ேᐻ⚛G㓀⚯፳G⁷❬ඇ⡗┧Gே㒯╃GⅯ⤨㒯షG⁴㒯ᇫG⛨├⛋ሻ.9)

❛ᤔ⁷⒫G⟇ඇ⤛ሿGௗ ឳG PSA ௗ ⚯G㗿☀⚗G⒜₈G⟜ⓨ⚓ឳG⤛㓠፯ඇG❛⛏G❛ᤔ⁷⒫ᐻ⚛G⟇ඇ┧G〧⤗㒯╃Gᠣ㒿⚓ឳ⊿G❛ᤔ⁷⒫⚓ឳG⛏㒳G ᤴᢷ⚛G୧⃣∳⿻ᇫGG⛟┟ሻ. ൏ᜃඇ┧GPSA ௗ ୗG⟇ඇ⤛ሿGௗ ឳG♷⚯㒯ሻషG⡓⛼㒯ᇫG╇ೃ⛧ᐻ⚗G PSA ጛ⛜G❛ᤔ⁷⒫⚓ឳG⛏㒳G ᤴᢷG ⛋⚯G‘ఛᣓG〧ೃ㒯ᇫG╇ೃᐻ⚛GⅯ㓠㓟ሻ. ⛋ᐻ⛋GⅯ㓠㒳G㓌≃❘⛏G╇ೃᇫG╄㒰(epidemiology) ╇ೃ╗ᇫ, ⛋ᇫG♛▗G୰⚗G㒰❘GேG♛ఛGୗGጛ⛜፯G╄㒰❘G⣴ேୗG⛓❘⚓ឳG୳ᰛG⣴ភGషG୰⚗G⃣ള᧿Gᰨᤃ㒰❘G╇ೃGఇG ሻG 㖬∻㒳G 㒰❘G ⣴ேឳG ⡓፯┟ඇG ᒣ⛋ሻ(Timmermans, 2010).

2000-2005ႛG ⛋┧GPSA ௗ ୗGጛ⛜፳G⤗╄┧G൏⤗G⒡⚗G⤗╄ሻG ᤴᢷ⛋G୧⃣㓟ሻᇫGള᧿G⤗╄G╇ೃᐻ⛋Gష፯┟ሻ(Oliver et al., 2000; Shibata

& Whittemore, 2001; Coldman et al., 2003; Shaw et al., 2004; Kopec et al., 2005).

2005ႛGೄG⛏ೃ⚯G 2/3ୗGே⡓㒯ᇫG⤗╄⚯G⤨ሿᐻ⚯G❛ᤔ⁷⒫G ᤴᢷG❛ᤔ⁷⒫G⒜₈G❬ጛ, ൏ᤃషG⟇ඇ⤛ሿGௗ ឳ⚯GPSA  ⛋⚯G‘ఛᣓGௗヷ㒯షG൏GఇG ᤴᢷ⛋Gစ⚗G⤗╄G PSA ௗ ୗG㖬 ፳G⤗╄⛋G⛓㒳ሻషGష㒳G Jemal et al.(2005)ᇫG♛⚯G╇ೃᐻG㒿ฯG⟇ඇ⤛ሿGௗ ឳ⚯G PSA ௗ ⚯G㗿ᇼ⚛Gᮈ㛟G⛜⣴㓋⡓ᇫG⯯ G╗ሻ. ⛋┧Gካ㓋, ୰⚗G㓋GNCI ᇫG╇ថGᰗ⛏⛋G⟇❬፳G❛ᤔ⁷⒫GG ᤴᢷ⛋G1995ႛょG2003ႛGጰ⒟G32.5%ឳG୧⃣㓟ሻᇫGఇᣓGⳳ㉧㓟ሻ. 㒯⛋ᵣᤃイ ⚯G㘛☧G㒯┧G PSA ௗ ᣓG⟇ඇ⤛ሿGௗ ឳG❬⮀∳⿻ᇫG♷⚯㒳G╇ೃᐻ⚛G❳㓋G╿Gⷋ〟ឳဧ(Catalona)ᇫG2001-2004ႛG ⛋Gೄ⚯G 50G⛋‘⚯G₈Gୗ☋G 50%ୗG⟇ඇ⤛ሿG ௗ ឳGPSA ௗ ᣓG⚛Gᤣ⿓G PSA ௗ ୗG౨ᯫ♛㒯Gጛ⛜፯┟ඇ┧G❛ᤔ⁷⒫G ᤴᢷ⛋G୧⃣㓟ሻషG⡓⛼㓟ሻ(Loeb & Catalona, 2008: 302).

9) (2001) .

൏ᝃG㗣⚯⡓⚯⛧ᐻ⚯G❧┧G⛋ᐻ⚗G ᤴᢷG୧⃣⚯G㒳G⣴ேୗG፯⤗Gᨒ㓟ሻ. ⤗╄G╇ೃᇫGሿ⤗G❨❘⛏G⣴ே╗⚛Gἧ,  ᤴᢷG୧⃣ୗGPSA ௗ Gጛ⛜ᤣ⚓ឳG⛋ᡛ➣ሻᇫG⤘❨❘⛏G⣴ேᇫG┋ᑫ┧ጛG┝┟ሻ. PSA ௗ ୗG⟇ඇ⤛ሿGௗ ឳGጛ⛜፯ᇫG 1990ႛG⚗G‟ឳ☋GᠣGᯬᐻ⛋Gᑈ⛼㒯ኯG∳ඇ╗ᇫ, ⛋ᝃ㒳G❛ᤔ⁷⒫Gᠣ⚯G㕘∷G⤛ሿGௗ ⚯G㕘∷G∳ඇ⚯G⛓ᇫGPSA ௗ Gጛ⛜G ᤴᢷG ⛋⚯GఛᣓG᧿㖏㒯Gᤣᐻ┟ሻ.10) ❛ᤔ⁷⒫Gᰨ⚯G⡓፳G♛㔯⛏⛧G⡨G㒯⛏Gᶛᤣ♿⛋G1990-2000ႛG ⛋┧G୧⃣㓟ሻᇫG ∻Gᕧ㒳G❛ᤔ⁷⒫G ᤴᢷG୧⃣ୗG❛❘⛏Gೄ⛏ᐻ⚯Gோ୬G㓼‘Gᒣ┧Gⓓඇ፳G⛋G⒛ሟဧᇫG⚯≃⚛GᝃG⛓⚓⺇ሻ(Etzioni et al., 2009: 13). ⛋▗Gካ┋, ⛋ᐻ⚗G EBM⚯G㒰❘G♛ఛGᣓG⛧∷ᐻ⚯G㗣⚯⚯GேឳG┋ᐻ╗ሻ. 㗣⚯⡓⚯⛧ᐻ⚗G PSA ௗ ⚯G㗿☀₈⚛G❬❘⚓ឳGష㒳G╇ೃᐻ⛋G᧿ᎧG⛨♛GᶛಧG⟇∻㔯(RCTs)⛋G⒛ሟ┟ඇ┧G୬㒳G୴₈⚛Gቋ㒯ඇG┋ឌሻషGᶛ㉧㓟ሻ. ⇻☿ዋGᣋ☿⛋G୰⚗G♷G⤗╄ᐻἧᤣG⒛ሟᛓGೄGဋG⤗╄GᶛಧᣓGㄌ㓋ጛGPSA ௗ Gጛ⛜G ᤴᢷG ⛋⚯G‘ఛୗG┝ሻᇫGGఇᣓGጛⳳ㒳G ╇ೃᐻ⛋G ష፯G 㗣⚯⡓⚯⛧ᐻ⚯G ⡓⛼┧G 㛯⚛G ∻┟ሻ(Lu-Yao et al.,

2002: 740; Sandblom et al., 2004; Concato et al., 2006).

⤗⚓ឳ, ❛ᤔ⁷⒫⛋G☇GᇧᤃG⒜₈⚓ឳG₈⛼㒯ᇫG⤟ᰨ⛋ᛓᇫG㈐₈⚛G㍃㒿㓋G⟇ඇ⤛ሿGௗ ឳGPSA⚯G㗿☀⚛Gௗヷ㒳G╇ೃᐻ⛋G୭G፷GⅯᤥ⚗G⟜⚯G㌏㓼(bias) ୗᇼ₈⛋G⤗❘፯┟ሻ. ⮏╃⛧G⁷〴⚯G㌏㓼, ⡗ GɒඇG㌏㓼,

ඇG⁻❬G∳G‴㒯ᇫG㌏㓼, 㖬㒯⤗G⒡⚗G㍃㒿/ᮇ❳Gඇ⡗⛋Gⓓඇ㒯ᇫG㌏㓼, ௗ G㓋⁴┧G㒳Gᥐௗ⚯G⟈, ∻㔯G⡨GሻᣏGᰨ☧⚓ឳG∻㔯G‘⛋G⛋ጰ㒯ᇫGG‴㒯ᇫG♛〘G㌏㓼GᑈGⅯGᤥ⚗G㌏㓼ᐻ⛋G∻❳G╇ೃ㔣ᐻ┧G

10) 1988 , 1989

FDA , 1990 Three-dimensional conformal radiation . 1980

1990 . Denmeade & Isaacs(2002) .

ః፯┟ሻ(Bunting, 2002: 73-75). ⛋G୰⚗G❧ᐻ⚛Gష㓋G᱓Gᒣ, 㗣⚯⡓⚯⛧ᐻ┧GPSA ௗ ᇫGWHOୗG❳∳㒳G⤛ሿGௗ ⚯G∻㓠G⟇ோ⚛G Gⴀ⟈∳⿻⤗ጛGᨒ㒯ᇫ, ⟇ඇ⤛ሿGௗ ឳG ☀፯ඇ┧ᇫG❳ୗG⛟ᇫGඇⅷ⯯ G╗ሻ.11)

㗣⚯⡓⚯⛧ᐻ⚗G PSAᣓG ☀㒳G⟇ඇ⤛ሿGௗ ⚯G㗿☀₈ἧᤣG⒛ሟᛓG൏Gௗ ୗGညᇫG⛨☀Gᕧ㒳G❳G–⒯ሻ.  ∻G❛ᤔ⁷⒫⚗GㄌG⒜₈Gሿఛඣ⤗G⤛㓠፯⤗G⒡ඇGᒣ┧, ሻⅯ⚯G₈ᐻ⚗G⛧∷⛋G❛ᤔ⁷⒫┧GតሻᇫG ∻⚛Gቂ⤗Gᨒ㒯షGඇGⅯඣ⤗GሻୗG ᤴ㒳ሻᇫG⛋G⛛‘⚯ᐻ⚯G‘∴⛋┟ሻ. ⛋⯯ GᰛሻᣏGషㄌ⛋GⅯ┧G╘㓼⚛G⡓⤗G⒡⒛G⛛‘❘⚓ឳG⚯ୗG┝ᇫG⒫ᐻ⚛G '♷ⅳ㒳G⒫'⛋ᛓషGᣋᇫ, 㗣⚯⡓⚯⛧ᐻ⛋Gඇ┧GPSA ⤛ሿGௗ ᇫG♷ⅳ㒳G⒫⟇⭿ጛG᧿ᎧG⤛ሿ㒯╃G㖯⛧ᐻ⛋G㒛◫㒳GᠣᣓGG㒯ᇫGሻ⤛ሿ(overdiagnosis)Gሻᠣ(overtreatment)⚯G❳ᣓGည⒯ሻ. 㗣⚯⡓⚯⛧ᐻ⚗G⛋┧Gካ㓋GPSA ௗ ⚯Gစ⚗G㈐⛋ጛGᒣ┧Gሿ⤗G❛ᤔ⁷Gᶛ⣴┧GតேG❬‘⛏G㖯⛧┧G㒛◫㒳G‴ௗ(biopsy)⚛GG㒯╃G‴ௗ┧GᒇᛓG‴㒯ᇫGషㄌ⚛G⣴ୗ∳〃GἧᤣG⒛ሟᛓG㉿㕟⣴G୰⚗G⛨☀⚛G♷㒿⚓ឳ⊿G㖯⛧⚯G‍⚯G⤟⚛G୧⃣∳⿻ᇫGఇᣓGⓓඇ㒳ሻషGᶛ㉧㓟ሻ(Marberger, 2007; Lilja et al.,

2008).

᪓ G⟇ඇ⤛ሿGௗ ឳG PSA ௗ ᣓG⤗⤗㒯ᇫG╇ೃ⛧ᐻGᕧ㒳G⛋G୰⚗G㗣⚯⡓⚯⛧ᐻ⚯G⛜⛼⚛G᧿ᎧGდ㒷GⅯG⛟┟ሻ. ╟ᣓGᐻ┋G㗣⚯⡓⚯⛧ᐻ⛋G❳G–ᇫG '♷ⅳ㒳G⒫'⚯Gఔ☇, ൏⚛G㖬㛟G❬⚯㒷G┋ᓷ㒳G㓀⚯፳GᯬጛG┝⚓ᧇ,

♷ⅳ㒯ሻషG⡓፯ᇫG⛋G┏❳G⒜₈G⟜ⓨ⚓ឳGጣᰗ㒷⤗ᣓG㉧ሿ㒷Gඇ⡗Gᕧ㒳G⟋✃㒯⤗G⒡ᇫሻ. ሻୗG㒛◫㒳G‴ௗGⅯୗG⣴፯┋G㖯⛧⚯G‍⚯G⤟⛋G୧⃣፯షGሻ⤛ሿ⛋G⛋ᠿ┋⤛ሻᇫG⚗Gᠣୗᇼ₈⚯G⡨◫₈⚛G㒳G⡓⛼⛋ሻ. ἧᤣG⒛ሟᛓG㒛◫㒳G‴ௗGⅯ⚯G❬ጛᇫG╄㒰❘Gඇ⡗⚓ឳG᱓Gఔ☇G⤗

11) Wilson & Junger(1968) (1) RCT (2)

, (3) , , , , (4) , (5) ,

.

Gሻ㒯⤗ᤣG⛛‘❘Gඇ⡗⚓ឳGᱏሻG☀⛏㒷ᤣ㒳GⅯ⡗⛋ሻ. ⛋ᐻ⚗G㕛⟋㒯ᇫG⣴ேGୗ☋GPSA ௗ ⚯G⛨☀┧G㒳Gდ⚯ᐻ⚯G㒰❘GேୗGᶟⓔ㒿⚛G⤗❘㒯ష, EBM⚯G㒰❘G♛ఛGᣓG⛋☀㒯╃G '⟇ೇG∳㔯'⚯GఇᣓG୬⟇㒯ᧇG㗣⚯⡓⚯⛧ᐻ⚛Gდ㓟ሻ. ⛋ᐻ⚗G 1990ႛG⛋㘛G⛋ᡛ⤛G❛ᤔ⁷⒫G╟G∳㔯(The Prostate Cancer Prevention Trial) ୰⚗Gള᧿G⟇ೇG∳㔯ᐻ⛋G㕛✃GPSA ❬‘ឳG⁻❬፳G4.0ng/mL ⛋㒯Gୗ☋┧ጛG20%⚯G㖯⛧ୗG❛ᤔ⁷⒫┧Gត⚛GⅯG⛟⚣⚛G╃⢃ᑆ⛋, ሻ⤛ሿGሻᇫG╻㛟G '⃣⤛ሿ(underdiagnosis)'

፯ᇫG⛋G❳ᛓషG⡓⛼㓟ሻ(Loeb & Catalona, 2007, 2008).

⛋GᎧG⛜⛼⚗G⛧GEBM⚯G㒰❘G⣴ே⚯G♛ఛGᣓG❛♷㒯╃G‘⚯Gდ⚯ᣓGდ㓟ሻ. PSA ௗ ᣓG⤗⤗㒯ᇫG⛜⛼⚯Gఔ☇G⛨☀⚛G୬⟇㒯ᇫG⛜⛼ᐻ⛋GEBM┧GᶛⳫ┋G᱓GᒣGᶟⓔ㒿⚛G⤗❘㓟ష, ⒛ୗG⛋ᣓGდ㒯ᇫG⟇ೇG╇ೃᐻ⚛G❳∳㒯╃G൏ᐻ⛋G⡓⛼㒯ᇫG㒛◫㒳G‴ௗ⚛GᠣGୗᇼ₈⚛G♛㓋G୧Ⅿ㒷GⅯG⛟ᇫG⛨⚗G♛㔯⚓ឳGⳬ⃣∳⺇ሻ. G㗣⚯❘⛏G⛜⛼⚯Gఔ☇GPSA ௗ ⚯G♷☀₈⚛G⛜⣴㒯ᇫGRCTs⚯G✃ᣓG⤗❘㒯ᧇG㒰❘GேୗG┝ሻషGᶛ㉧㓟ష, ⒛ୗGⳫୗ❘⛏G‴ௗ⚛G⟇ඇGௗ⤛⚛Gㄌ㓋G┒⚛GⅯG⛟ᇫG⛋⛌ሻGካG⿇G㓋ᣓGୗ➏▃GⅯG⛟ᇫG⸻ሻᛗG♛㔯⚓ឳGള❬㓟ሻ.

╃ඇ┧Gኾᳰ╃G⛋ᐻ⚗Gష፳G㒰❘G⣴ேᣓGឳGሻᣋG㓋⁴㓟ᇫ, ⛋ᝃ㒳G㓋⁴⚯G⭿⛋ᇫG⟇ඇ⤛ሿGௗ ឳG PSA ௗ ᣓGጛ⛜㒯ᇫG 1990ႛG┧Gೄ⚯G❛ᤔ⁷⒫G♷ᰨ♿⛋Gൠ⣴㒳GG㒳GᎧG⛜⛼⚯G‘፯ᇫG⁻┧Gᐳᝃሻ. PSA ௗ G⤗⤗⛧ᐻ⚗GPSA ௗ Gጛ⛜G∳ඇ┧G❛ᤔ⁷⒫G♷ᰨ♿⛋Gൠ⣴㒳G⛋♷ᣓGPSA ௗ ⚯Gჩ⚗G〧⤗♿Gኬ⛋ᛓషG⡓⛼㒯ᧇGPSA ௗ ⚯G☇Ⅿ₈⚛G⣴㒯ᇫGேឳG⒛ᐻ╗ኯG┧, 㗣⚯⡓⚯⛧ᐻ⚗G൏G୰⚗G♷ᰨ♿⚯Gൠ⣴⚗G '♷ⅳ㒳G⒫'ඣ⤗Gః㒯╃G㒛◫㒳GᠣᣓG⣴∳⿻ᇫGPSA ௗ ୗGညᇫG❳⛏G 'ሻ⤛ሿ'⚛G ୗ⛼G ⛯G ╃⡓ᇫG 㕛‘⚓ឳG ⛋㓋㓟ሻ(Loeb & Catalona,

2008: 303; Lilja et al., 2008: 269).

⛋ᐻ⚗GEBM⚛Gდ✘⚯G⛧☧⚓ឳG–⒛GඇG‘⚛Gდ㒯G∳ጛ㓟⤗ᤣ,

EBM⚯G (㓋⁴❘) ♷╇₈⚗G PSA ௗ ⚯G⤗⤗GGG⤛╘GⓨG᧿Ꭷ┧G

‘⚛Gఇ❬❘⚓ឳGᙿᤃ⤗Gᨒ㒯Gᤣᐻ┟ሻ. ఇೄGᎧG⛜⛼G᧿ᎧG⛧∷ᐻ⚯G⡓⛼⛋G‘⚯G⡓⛼ሻG㘿⒃G☇Ⅿ㒯ሻᇫG❧⚛G⛜⣴㒷GⅯG┝┟ඇ┧G⟇ඇ⤛ሿG ௗ ឳG PSA ௗ ᇫG დᛗG ⒟❬₈⚛G ⒟షG ୟG ⅯG ┧G ┝┟ሻ.

ACS, AUA ᑈG㒿ฯG⟇ඇ⤛ሿGௗ ឳ⚯GPSAᣓG⤗⤗㒯ᇫG❛ୗG⤨ሿG⛋┧G㗣⚯❘⛏GUSPTSF, ACP, AAFP ⃣⃤⚯G╇ೃ⛧G᧿ᎧGEBM⛋GఇೄG⛧∷ᐻ⚯G㌏⛋G፷G⛋ᛓషG᭖┟ሻ. ⛋ᐻ⚗G 2009 - 2010ႛG ⛋┧Gష፷G♷GೄGⓨ⚯Gള᧿GRCTsᤣ⛋Gდᛗ⚛G⛷✃☣G⡛G 'ఇ❬❘G∻㔯'⛋G፯┋⡛G⛋ᛓషGඇ㓟ሻ(Pienta, 2009: 18; Hermandez & Canby-Hagino, 2009: 55).

4. ே⡨≃⚯㒰⚯G㒳ఛ?: �‘ఇ❬❘G∻㔯�’⚯Gᮇ∷G‍⚯ ⤟Gୗ⚯G‘

2009ႛ, PSA ௗ ⚯G⟇ඇ⤛ሿGௗ ឳ⚯G㗿☀⚛G㉧ୗᣛG㓋⡛G 'ఇ❬❘G∻㔯'⚓ឳGඇ፯ኯGᎧG୳⚯Gള᧿G⛨♛G⛛‘∻㔯GఇୗGష፯┟ሻ. 㒯ᇫG♷┧G Ⅿ㓠፳G ❛ᤔ⁷⒫⚛G ♛㒳G ERSPC(European Randomized Screening for

Prostate Cancer)╗ష, ሻᣏG 㒯ᇫG ೄ┧G Ⅿ㓠፳G PLCO (Prostate, Lung,

Colorectal, & Ovarian Cancer Screening Trial)╗ሻ. ᇋるG౨㒰G⛋⚯G 'ఇ❬❘⛏G∻㔯'⯯ Gሻᡛ➣ኯGᇋる⚯G㑛ᤃ⣯G∻㔯⛋Gඇ∻Gቐ┧ᇫG❛㕗G �‘ఇ❬❘�’⛋⤗G⒡⒯⚛G ἧᤣG ⒛ሟᛓG ╃ᝃG 㖬∻₈⚛G ဋ㍃㒳G ∻㔯⚓ឳG ᐳᝃG ▗G ୰⛋(Schaffer, 1989), ⛋GᎧGള᧿GRCTs ᕧ㒳G╇ೃ⛧ᐻ⚯Gඇ▗GቃᤃG❳ᣓG㓋ఇ㒷Gఇ❬❘⛏G⣴ேୗG፯⤗Gᨒ㓟ሻ. ERSPCᇫG PSAᣓG⟇ඇGௗ⤛Gௗ ឳG ☀㒳GఇG♷⚯㒳G❛ᤔ⁷⒫G ᤴᢷG୧⃣ୗG⛓┋ဃሻషGష㒳G, PLCOᇫG⟇ೇGᶛಧ㒯╃G┋ᓷ㒳G⭿⛋ጛGః፯⤗G⒡⒯ሻᇫGఇᣓGጛⳳ㓟ሻ(Barry,

2009: 1351-1354).

ᎧG RCTsୗGឳG‘ⴀ㒯ᇫGఇᣓGဋც⛧, ⟇ඇ⤛ሿGௗ ឳG PSAᣓG⤗⤗

㒯ᇫG⮃₈⛧▗G㗣⚯⛧G ⛋┧Gሻ∳GᎧG╇ೃఇ⚯G㓋⁴┧G㒳Gდᛗ⛋G⛓┋ဃሻ. ⛋ᐻ⚗G᧿ᎧG⛧∷ᐻ⚯G⛜⛼G፯ᇫGRCTs ୗG '㒰❘⚓ឳG▃ᣏ' ∻㔯⛋G⒛ሯ⚛G⛋ᇫG⤗❧ᐻ⚛G⮕⒛ရ⚓ឳ⊿G‘Gდ⚯⚯G㒰₈⚛Gდ㒯G∳ጛ㓟ሻ. ╟ᣓGᐻ┋GPSA ▐㖏⛧ᇫG ᤴᢷG୧⃣▗GPSA ⟇ඇ⤛ሿGௗ G ⛋⚯G‘ఛୗG┝ሻషGష㒳Gೄ⚯G PLCO ╇ೃୗGㄌ❳⤨ሿ⚛G❳ឳG⁻❬㒯⤗Gᨒ㓟ሻషG❳❳ඇ㓟ሻ. ㄌ❳⤨ሿGୗ☋G❟ Gୗඣ⛋ୗGPSA ௗ ᣓG⒯ඇGᒣ┧G ∻‘G⛯ᨒ፳G╇ೃᛓᇫG⛋ሻ. ឳGPSA 㗣⚯⛧⚯Gఔ☇G‘ఛୗG⛟ሻషGష㒳GERSPC⚯G╇ೃୗG❳ឳGᮇ╋፯⤗Gᨒ㓟ሻషG⤗❘㓟ሻ. ⛋ᐻ⛋Gඇ┧GERSPCᇫGឳGሻᣏGௗ⤛G∴Gௗ⤛GఇᣓGⳫ❘㒯ඇG♛㓋GሻᣏGඇ⡗, ሻᣏG⛨♛Gጛ∴, ❛ᜌᐻ⚛G ☀㒳G╃ᝃGೄୗᐻ⚯G╇ೃఇᣓG ⟜㓀㒳G ⛋ඇ┧G ∷᠇㒯ඇG ┋☋G ⛋ょ╗ሻ. ἧᤣG ⒛ሟᛓ, ᎧGRCTs  ⛋⚯G╇ೃG⁻ఛG⭿⛋Gᕧ㒳Gდ✘⚯G‘⚓ឳG‘㓟ሻ. ⛓ភឳG PLCO

ᇫG PSA ‘㒳ᣓG 4.0ng/mLឳG⁻ఛ㒳GGERSPC ᇫG 3.0ng/mLឳG⁻❬㓟ඇ┧G〧⤗♿┧G⭿⛋ୗG⛟⚛GⅯ┧G┝┟ሻ.

ఇೄG PSAᣓG⟇ඇ⤛ሿGௗ ឳG ☀㒯ᇫG⚛G⤗⤗㒯ᇫG⛜⛼⚯G╇ೃ⛧ᐻ⚗G൏⛋Gጛ⛜፳G⤗G 20ႛ┧Gୗඣ☋GඇGጰ⒟GPSA⚯G㗿☀⚛G⛜⣴㒷GEBM┧G⛜㒳G '㖬ష㒳G⣴ே'ᣓG㒯⤗Gᨒ㓟ሻ. ᶛ G㗣⚯⡓⚯⛧ᐻG╄∳G☀㒿⚛G⛜⣴㒷ᤣ㒳G 'ఇ❬❘G ⣴ே'ᣓG 㖬㒯⤗G ᨒ㓟⤗ᤣG ⛋ሻ. ⛋G ୰⚗G ‘㗀┧GNACB(National Academy of Clinical Biochemistry) ୰⛋G 2000ႛGᤣG㒯ካᛓጛGPSAᣓG⛋☀㒳G⟇ඇ⤛ሿGௗ ┧G㖏⚯❘⛏G⤨ሿᐻGᕧ㒳G❧⭿GⳫ⯳㒯⤗G⒡ᇫG㓼⚓ឳG⛜⛼⚛G⁷㗣㒯╗ሻ(Sturgeon, 2008).

ᶛ Gሿ┏㒯උG┋ឌ⤗ᤣ, ⛋ᝃ㒳G⛜⛼⚯G⁷㗣ᇫGೄ⛋G⚯ⓔ㏟Gള❳Gᑈ┧G ❛⡓⚯G☧ⶰ(precautionary principle)⚛G❘☀㓋G╿GG፳ሻ(㒯Ⰴ, 2010:

151).  ❛⡓⚯G☧ⶰ⚗G ☀፯ᇫGᛔ┧GᒇᛓG൏G❬⚯ୗGቃᛓ⤗ඇGᒣ┧G∳㖫፯ඇG┋☇, ேG㓋G㖬㒳G㒰❘G ∻⛋G㖬ᤔ፯⤗G⒡⚗Gఔ☇G♛㔯⚛Gఔ୧∳⿻ඇG♛㒳G❬⮜⚛G☇⁷㓋G㌓ᇫG⚛Gᚒ㒳ሻ. ⚯㒰⚯Gᛔ┧G 㒯⛧, ⛋ᇫG ⤟ᰨ┧G ត⚣┧ጛG ೃ㒯షG ః፯⤗G ⒡ᇫG ♛⚣₈

(false-negative) ᶛ♿⚛GစⳫᇫGᤵⴛኯG❧⚛G⤟ᰨ┧Gᤃ⤗G⒡⒯⚣┧ጛGೃ㒯షG⤟ᰨ┧GᤇG⚓ឳG⛯ᨒG㉧ሿ፯ᇫG♛ⓨ₈(false-positive) ᶛ♿⚛GစⳫᇫG㓼⚓ឳG▅ඇᇫG⚛G⚯㒳ሻ(Barrett & Raffensperger, 1999). PSA ௗ ᣓG⟇ඇௗ⤛⚓ឳG ☀㒯ᇫG⛨├⛋G♛㔯㒯ሻᇫG⣴ேୗG㖬㒯⤛G⒡⒯⤗ᤣ, PSA ௗ ⚯G㗿☀₈┧G㒳G㖬∻㒳G⣴ேୗGఛ⃤㓋Gᑈ⛼㒯⤗G⒡ᇫG‘㗀┧G⤗⃤፯ᇫGჩ⚗G♛ⓨ₈ᢷ⚗G ❛⡓⚯G☧ⶰ┧G⚯ே㓋G⛋G⚯ᠣඇⅷ⚛G⟇ඇௗ⤛┧G ☀㒯ᇫG⚛Gே㒷GⅯG⛟ᇫGேୗG፯┟ሻ(Sturgeon, 2008).

PSA ௗ GጛೃG⛧Ⰻ⚯G㎳⡗㖫G❳Gᕧ㒳GPSA ▐㖏⛧ᐻ⚯G⛜⛼⛋Gൠ㒯Gඇ⚛G⛚ᇫGඇ╃㓟ሻ. ᤥ⚗G╇ೃ⛧ᐻ⛋GேG㒯⛋ᵣᤃイ Gඇ⡗⚯GೃGRIAᐻG1998-1999ႛ┧G‟ឳ⛋G❳❬፳GWHO ㎳⡗⚯GRIA ᐻG ⛋⚯G⭿⛋ୗGညᇫG❳┧G㓋G∴❘⚓ឳG┏ൠ㒯షG❳G–⒯⤗ᤣ, ⛋ᣓG㖬㛟G㓋ఇ㒷Gᯬ⛋G┝ᇫG‘㗀┧G⛋ᐻ⚗Gሿ⤗G"㒛◫㒯" ‟ឳ☋G㎳⡗⚛Gጛ⛜㒯╃G"㖓ᛗ⚛Gୗ⤗షG╿" WHO▗GG❬ᣓGᶛ㒯ேG⛛‘⚯ᐻ⛋G⛋ᝃ㒳G㕛∻⚛G⛯G⛏⤗㓋ⓓG㒳ሻᇫGቐ┧G㒷GⅯG┝┟ሻ(Cook, 2008).12)

൏ᝃG⛋ᐻሻGካG⡨◫㒳G◫⛏⚗GឳG '㖯⛧⚯G‍⚯G⤟'⛋G❛ㄌ❘⛏G⛌⁴G∴⚛Gᇼୗ㒯ேG╃ඇ┧G⡓◫㒳G◫⃣ឳG㍃㒿፷Gᤣ⿓G୬㒳GୗឳGᎧ㓟ሻᇫGG⛟ሻ. 1990ႛGょG∳⛨፯┋G2000ႛG⡨┧Gୗ⛼Gୗ╋፯┟ኯGEBM ጛ⛜┧G㒳G⚯ᠣఛGဋ●⚯Gᶛ㉧⚗G㒰❘G⣴ேG♛ఛG▗G୰⚗G㎳ᣓGᒇᛓG㓠㒯ᇫG㓀ᤃ❘G⚯ ఇ❬⛋G⚯ᠣᣓG〟⛏㖫(dehumanized)

㒳ሻᇫG⛋┟ሻ. EBM┧G㓋G❳❳ඇ㒯ᇫG╇ೃ⛧ᐻ⚗GEBM⛋G㖯⛧⚯G‍⚯G⤟⚛Gష㒯⤗G⒡ᇫሻషG୬㒯Gᶛ㉧㓟ሻ(Faulkner & Thomas, 2002). ⛋ᝃ㒳G㚧ᣛG⃤┧G╇ೃ⛧ᐻ⚗G㖯⛧ᐻ⚯G‍⚯G⤟⚛Gష㒯ᇫG⛏ᱏ⡓⚯G⚯㒰(humanistic

12) PSA 4.0ng/mL 1984 RIA. 2000 1984

RIA RIA . RIA WHO WHO

RIA . RIA PSA 4.0ng/mL WHO

RIA 3.0-3.5ng/mL 20% .

medicine) 㖐⚗Gୗ⡨≃G⚯㒰(value-based medicine)⚛G⡓⮔㓟⚓ᧇ(Petrova et al.,

2006), ‍⚯G⤟⚛G⛌⁴⚯G⡓◫GᰗⅯឳGጛ⛜㒯ᇫGᑈ⚯G∴⚓ឳGEBM⚛G▛㒯ඇᣓG◫Ⰴ㓟ሻ(Brown & Brown, 2002; Little, 2002; Ventegodt et al., 2004). ൏ᤃషG⛋ᝃ㒳Gᒣ┧Gᤵ᪓, ‍⚯G⤟⚛G❬ᜠ㖫㒯╃G❬㒷GⅯG⛟ᇫGᯬᐻGᕧ㒳G‘ቐ㛟G❛㒯╗ሻ(Will & Moreira, 2010: 5). ⛋┧Gካ㓋, ೄGဋ┧G⚯ᠣඇⅷ╘㓼㌠ୗᣓGᤸᇫGAHRQ(Agency for Healthcare Research and Quality)ୗG2005ႛG⛋㘛G❧⚛G㖯⛧⡨≃₈╇ೃ(patient-centered outcomes research) ♛⡓ឳG୳㌏㒯G‍⚯G⤟⚗Gካ☈G⡨◫㒳GୗឳG‘㒯╗ሻ(Tyutyulkova, 2011).

ᶛ GೄG⛋┟⤗ᤣ, PSA ௗ ▗G㓋ጛG㖯⛧⚯G‍⚯G⤟⛋G⡨◫⤗㎳ឳG㍃㒿፳G⛛‘∳㔯ᐻ⛋GⅯᤔ፯ඇG∳⛨㓟ሻ. ╟ᣓGᐻ┋G2000ႛGG╘ೄ┧G❛ᤔ⁷⒫GᠣGᯬᐻG⚯G㗿☀₈⚛Gᶛಧ㒯ඇG♛㓋GᶛᥐௗGRCT⛏GProtect

TୗG∳㓠፯┟ᇫ, ⛋G RCTᇫGୗ❘⚓ឳG PSA ௗ ⚯G㗿☀₈⚛Gௗヷ㒯ᇫGᨀ❘⚛G⤗ሟషG⛟┟ሻ. ⛋❛G∳ඇ┧GⅯᤔ፳G RCTs▗Gቃᤃ, ⛋G RCT┧ᇫG㖯⛧⚯G‍⚯G⤟⛋G⡨◫㒳GషG◫⃣ឳG㍃㒿፯┟ష, ⛋●┧ጛG⭿❘⚓ឳGோᶛ⇻G╇ೃG㑛ឳ❴㈏ᛗG⛋ᣛ⚓ឳG⛛‘∳㔯G⮏╃㖯⛧ᐻ⚯G‍⚯G⤟┧G㒳Gⓨ❘G㌠ୗୗG㒿ฯG⛋ᠿ┋➣ሻ(Faulkner, 2010: 148-149).

⛋G㖯⛧⚯G‍⚯G⤟⛋G EBM ⚛G⤗⤗㒯ᇫG╇ೃ⛧ᐻG ⛋┧ጛG⡨㒳GୗGୗ☋G㒯ឳG‘㒯, ேG⡓ᨀ⤗G⒡ኯGሻ⤛ሿGሻᠣឳG⛏㒳G㖯⛧⚯G‍⚯G⤟G୧ㅋᇫG☇G⡨◫㒳G❳ឳGᓷ▃ᛧሻ. PSA ௗ⤛G▐㖏⛧Gୗ☋G⛓ᇫG╻㛟G㕛✃G⃣⤛ሿ⛋G❳ᛓᇫGே▗Gጰ⛓㒳G⡓⛼⚛G㌓ⰻ⤗ᤣ(Tosoian & Loeb, 2010), ⛋ᝃ㒳G ⡓⛼⚗G ⁻ᐴ⛋G ┝┋╗ሻ. ᶛG2009ႛ┧Gష፳GᎧG㕬GRCTs⛏GPLCO▗GERSPCୗGPSA ௗ ⚯G♷㗿₈┧G㓋GឳGሻᣏGఇ⚛Gဋត⤗ᤣ, PSA 㗣⚯⡓⚯⛧ᐻ⚗G⛋GᎧG╇ೃGఇG᧿ᎧୗGPSA ௗ ୗGሻ⤛ሿGሻᠣᣓGညᇫሻషGష㓟ኯG❧⚛G୬⟇㒯ష, ⛋⛋G⡨◫㒳G❳ᛓషG⡓⛼㓟ሻ(Howrely et al., 2013). ╟ᣓGᐻ┋G Brawley(2009)ᇫG♷⚯G╇ೃఇ(ERSPC)ୗGPSA ௗ ▗G ᤴᢷG୧⃣G ⛋┧G‘ఛୗG⛟ሻషGష㓟⤗ᤣG�“ሻ⤛ሿ⚛Gష㒷Gఔ☇, ┓Gᤥ⚗G ᛣᐻ⛋G⒛⒯ᇫ⤗

┧G㒳G‴⟋Gㄌఛᤣ⚓ឳGௗ⤛⚯G❬❘⛏G㗿ᣓGఇ❬㒷GⅯᇫG┝ሻ�”షG⡓⛼㓟ሻ.

2012ႛGၻኳᛗᐳG┧ᛓ⇻⇻⚯㒰ₓょG╇ೃ⛧ᐻ⚗GPSA ௗ ᣓG ☀㒳G⟇ඇ⤛ሿ⛋G❛ᤔ⁷⒫G ᤴᢷ⚛G୧⃣∳ሻషGష㒳G ERSPC⚯Gఇ┧G㓋, ‍⚯G⤟Gᑈ⚛Gష㒷Gఔ☇G☧ᛯ⚯GఇሻG23% ୗᜠG㗿☀⛋G⡛┋ᐷሻషG⡓⛼㓟ሻ. ⛋▗G㒿ฯGPSA ௗ ᣓG⟇ඇ⤛ሿGጛೃឳG ☀㒯ඇG♛㓋ᇫG‍⚯G⤟⚛G⁴㒯ᇫG⛨├⛋G◫ೃ፳ሻషGኾᳰ╗ሻ(Heijnsdijk et al., 2012). ‍⚯G⤟⚯G⚛Gష㒯G፯, ᎧGRCTsᇫG᧿ᎧG㗣⚯⡓⚯⛧⚯G㌏⚛Gᐻ┋⡗G⛋ሻ.

㖯⛧⚯G‍⚯G⤟⛋ᛓᇫG �‘ 㗣❘�’ ୗୗG EBM ဋឳGㄌ㓀፯, 㗣⚯⡓⚯⛧ᐻ⚗GEBM⚯G⛋ᣛ⚛GᶣGPSA ௗ ⚯G㗿☀₈⚛G �‘㒰❘⚓ឳ�’ დ㒯ඇG∳⛨㓟ሻ. PSA ௗ ⚯G♷㗿₈⛋G㒰❘G♛ఛG┧GᒇᛓG⛜⣴፯⤗Gᨒ㒳G‘㗀┧, ⛋Gௗ ୗG‍⚯G⤟⚛G㓋ⶳሻ, ‍⚯G⤟⚛Gష㒳G⛌⁴⚯Gდᤃ┧GᒇᛓGቐ╇㛟Gே㒯ᇫG⛋G㓀ᤃ❘⛏G㒰❘G〳ጛୗG፯ᇫG⛋ሻ. ඇ∻G 2011ႛG10☫Gೄ⤟ᰨ╟ᤃᱏ (USPSTF)ୗG PSA ௗ ┧GᶛషGᑈൠ⚛GఓኯGG⛧ⰋୗG �‘EBM'⚯Gᛔ┧G൏⛋Gୗ➏▃G⒫ ᤴᢷG╟┧G㒳G⛌⁴GⅯሻGሻ⤛ሿGᑈ⛋Gည⚛G⛨☀⚯G㒓㓋┧GᒇᣏG㖯⛧G‍⚯G⤟G୧⃣┧GካGᣓGᎫGG⛋ᡛ⤛G⛋┟ሻ(ᦫᑫⷓ㍃⸻⇻, 2012). 㖯⛧⚯G‍⚯G⤟⛋GEBM

┧Gష㓋ⓓG㒷GୗឳGᰗ㖫㒯, PSA ▐㖏⛧ᐻ⚯G⡓⛼⚗G �‘⛓㖫�’┧G⚯⟋㒯ᇫGG⛯Gᐳᝃᑆ⛋G❧⭿G㓀ᤃ❘GேୗGⓔ㒳G �‘ᶛ㒰❘�’⛏G⛋⛧Gఔ❳❘G⛋㓋ఛ▗G୰⚗G �‘ 㗣❘�’ ◫⃣┧Gඇ㒳G 'ᶛ㓀ᤃ❘'⛏G⛜⛼⚓ឳGᶛⴇ⤗ඇG∳⛨㓟ሻ.

5. ఇ

⛋Gൗ⚗Gೄ⚛G⡨≃⚓ឳG1970-2012ႛGጰ⒟⚯GPSA ௗ Gඇⅷ⚯G❘⚛G〧ೃ㓟ሻ. 1970ႛょGః፯షG〧ೃ፯ඇG∳⛨㒳G PSAᇫG♷㒳G❛ᤔ⁷⒫G㎳⤗⛧

ឳG‘㓟ష, 1990ႛᣓGேⰧG❛ᤔ⁷⒫Gᰨඇ⚯G⮇G᭦GᤃGጛೃឳGᶛᄿඇG∻㓠┧Gඡⅰ⛋Gἣᤃ⒯ሻ. ୰⚗G∳ඇ┧, PSA ⟇ඇ⤛ሿGௗ G⡓⮔⛧ᐻ⚗G⟜G❛ᜌ⚛Gㄌ㓋GPSAୗG⟇ඇ⤛ሿGௗ GጛೃឳG⛏⡗GᇫGG₈⚛GேᎧ┟ሻ. ൏ᝃG❛ᤔ⁷⒫G⮇⚯G㎳⡗⚓ឳG㖬ష㒯G⛧ᤃᣓGೊ㛣GGቃᤃ, ⟇ඇ⤛ሿG ጛೃឳ⚯G PSAᇫG ⛛┝ᇫG ▗G 㗣⚯⚯G ᅟᤃ┧G ∳ቃⓓ㓟⚓ᧇ,

൏⚯G㗿☀₈G⛨☀⚛GᎯᝃ≏షG⤗⃤❘⛏Gდᛗ⛋Gᯣ┋➣ሻ. დᛗ⚛G⟇ൟ⛋ᛓጛG ∴∳⿻ඇG ♛㓋G ⟇ඇ⤛ሿG ௗ ୗG ୭ᇫG ❬㖬ጛᣓG ჩ⛋ᇫG ⚗GPSA ጛೃG⛧ⰋᣓG㎳⡗㖫㒯ᇫG∳ጛឳG⛋┋➣⤗ᤣ, ⛋ᇫG╻㛟G‟ឳ☋G❳ឳG‘㒯╃GᕧGሻᣏGდ✘⚛G⛓⚓⺇ሻ.

EBM⚗G⛋ᝃ㒳G╄ ❘G❘G⃤┧G⛋⡨⚯G⚯ឳG �‘♷╇㒯�’ ⛨ጰ㒯╗ሻ.

ᦓ❗G EBM⚗G PSA ௗ Gდ✘Gୗ☋G⛋Gඇⅷ⚛G▐㖏㒯ேG㒯ᇫG㓠♛⛧Gⓨ┧G⚯㓋G '♷╇㒯'  ☀፯┟ሻ. ⟇ඇ⤛ሿGௗ ឳGPSA⚯G㗿☀₈⚛G⤗⤗㒯ᇫG╇ೃ⛧ᐻ⚗GEBM⛋G❳∳㒯ᇫG㒰❘G⣴ேG♛ఛGୗGള᧿G╄㒰G╇ೃ┧G╃㒯ᇫG㈐⚛G⛋☀㒯╃Gള᧿G⤨ሿG╇ೃᣓGㄌ㓋G㗿☀₈┧G㒳G '㖬ష㒳' 㒰❘G⣴ேᣓG㗤ᐴ㒯G㓟ሻ. 㗣⚯⡓⚯⛧ᐻG╄∳GEBM⚯G㒰❘G⣴ேG♛ఛGᣓGషGᐻ┋▗G⛋G♛ఛG‘GሻG♷㒳G⣴ே⛏G RCTsୗG┝ᇫG‘㗀⚛G⤗❘㒯G㗿☀₈┧G㓋G❳ᣓG❳ඇ㓟ሻ. ⓨ⚗G⛋G╇ೃ፳G╄㒰G╇ೃGఇ┧G㓋ጛGሻᣏG㓋⁴⚛Gဋც⚓Gⴀጣ㓟ష, ⛧∷ᐻ⚯G⡓⛼G♛ᮇ፯ᇫGఇᣓGဋც⚗G 2009ႛGᎧGള᧿GRCT ╇ೃ┧G㒳G╇ೃG㌏㓼ᐻ⚛G⤗❘㒯ᧇG⛧∷ᐻ⚯G⡓⛼⚛G㓀ᤃ㖫㓟ሻ.

൏ᝃGே⡨≃G⚯ ఇ❬GⰋఛᣓG♛㒳G⛧ᠣᣓG❳㒯ᇫGUSPSTFୗG2011ႛGPSA ௗ ┧GᶛషGᑈൠ⚛GඋGᐳᝃᑆGGPSA 㗣⚯⡓⚯G⤛╘⚯Gᨀ⃣ᤃୗG⮃₈G⚛G⒬ጛ㒯G፯ᇫ,13) ⛋ᝃ㒳Gᰗ㖫⚯G⡓◫㒳Gᮇఔ┧ᇫG╄ ❘G

13) . PSA , ' '

, PSA USPSTF PSA

(

ᛔG⃤┧Gᶛ㉧ᐻ⚛GⅯ☀㒯ᧇGఛ⃤㓋G⤛㖫㒯ᇫGEBM⚯G♷╇₈Gኬ⛋┟ሻ.

1990ႛG G �‘〟⛏㖫�’┧G㒳Gᶛ㉧G㒿ฯG㖯⛧⚯G‍⚯G⤟⛋G⡨◫㒯Gష፯┋ⓓG㒷GୗឳG‘㒯, EBM ဋឳG㖯⛧⚯G‍⚯G⤟⛋G⡨◫GୗឳGㄌ㓀፯┟ሻ. ൏GఇGPSA 㗣⚯⡓⚯⛧ᐻ⚗G2009ႛGᎧGള᧿GRCTs┧G㖯⛧ᐻ⚯G‍⚯G⤟⚛G㓋ᇫGሻ⤛ሿGሻᠣୗGⓨ ፯ᇫG⛓⛋G✃㖬⛏G፷G❬ጛឳGᮈ㒯ᧇ, ⛋ᝃ㒳G‍⚯G⤟⚛Gష㓋᱓GᒣGᐴሻᇫG∻⛋Gᤥ⚗Gௗ ᛓషG⡓⛼㓟ሻ. ൏ᤃషG⛋G‍⚯G⤟⛋G EBM ဋឳGㄌ㓀┧GᒇᛓG⛋ᐻ⚗G 'EBM'⚯G⛋ᣛ⚛GPSA ⮃₈⛧ᐻឳょG▛❛㛟G⒮⚛GⅯG⛟┟ሻ. ఇೄG㕛✃GPSA 㗣⚯⡓⚯⛧⚯G⡓⛼⛋GEBM⛋ᛗG〗⛋㈗⚛GቃG፳G⚗G㒰❘G⣴ே⚯G♛ఛG┧ᤣGே㓋G⛋ᡛ⤛G⛋G⒛ሟᛓG‍⚯G⤟⛋ᛗG⛓⟜⚯G 㗣❘GୗୗGEBM ဋ┧G㍃㒿፯ᇫG╄ ❘G❬┧G⚯㓋Gᤣᐻ┋⤛Gఇ╗ኯG⛋ሻ. ┞⛋G EBM

┧G㍃㒿፷ᤣ㒳G㒰❘G⣴ே⚯G⛓⛋ష, ┋ᇧG◫⃣ୗG EBM┧G⚯㓋G㒰❘⚓ឳGካG⡨◫㒳GୗᣓGᎧ┋ⓓG㒷G‘⛏⤗ᣓG❬㒯ᇫG⚗G∳❘⚓ឳG⡓┋⤛GG⒛ሟᛓG╄ ❘GఔឳG⃤┧G⛛┝⛋G㕬₈፯షGᰗ㖫㒯ᇫG☇╇❘⛏G⛋ሻ.

EBM⚗GPSA ௗ Gდ✘G⃤┧Gⓨ⚯G⛧☧⚓ឳG⛋☀፯┟⚓ᧇ, ‍⚯G⤟⛋ᛓᇫGୗୗGEBM⚯G⡓◫G◫⃣ឳG㍃㒿፯ᇫG╄ ❘Gᛔ┧G⚯㓋G㒳G⚯G⛜⛼⚛G⤗⤗㒯ᇫG⚓ឳGᤃG፯┟ሻ.

㈐❬㒳Gඇⅷ㒰❘G‘(technoscientific object)⚛GᎯᝃ≏షGᯣ┋⤗ᇫGდ✘┧GEBM⛋G㓠♛⛧ᐻ⚯Gდ✘⚯G⛧☧⚓ឳG ☀፯ష, ൏┧GᒇᛓGឳGሻᣋG㓋⁴፯ᧇG╄ ❘⚓ឳGᰗ㖫㒯ᇫG‘⛋ᛓᇫG❧⚛GቂᇫG⛓⚗G㕛G⚯ᠣඇⅷ⚛GᎯᝃ≓Gდ✘⚛Gௗヷ㒷GᒣG⡨◫㒯ሻ. ⛋G❧⚛G୬⟇㒯ඇG♛㓋GᱏG╇ೃ⛧ᇫGEBM

⛋GᎧGୗ⤗G⚯┧G♷╇㒿⚛Gୗ➣⚣⚛G⡓⛼㒳G⛋ሻ. ⛓ភឳGFaulkner(2009,

2010, 2012)ᇫG PSA ⤛ሿௗ ┧G㒳G╘ೄG⚯ᠣඇⅷ╘㓼㌠ୗ┧G⤘❨G⮏╃㒯షG⛋┧G㒳G╃ᝃG⁴⚛Gဋ▫ᇫ, ൏ᇫG 1990ႛG⡨ GPSA ⤛ሿGௗ ⚯G㒰❘G㖬∻₈┧G㒳G⚯ೃ≃⛋G╘ೄGဋ┧G㖬 ፯ᇫG⛋♷ᣓGቐ∳G╘ೄ┧G

, 2011).

EBM⛋GோG❬⮜⚯G⡨≃⚓ឳG‘㒯ᇫGᛔ┧G⮕ᇫሻ(Faulkner, 2012: 63).

⛋ᝃ㒳G❧⚗G PSA 㗣⚯⡓⚯⛧ᐻ⚯G⛋㓋ᤣ⛋G EBM┧Gே㒳G⛋ᛗG‴┧Gඇ㒯ᇫ, ⛋ᇫGᱏG ភG╇ೃ┧Gᐳᝃဃᑆ⛋GPSA ⤗⤗⛧ᐻGᕧ㒳Gⲳඣ⤗GEBM⚯G⛋ᣛ⚓ឳG⛧∷ᐻ⚯G⛜⛼⚛G୳⤛㓋▫ሻᇫG❧⚛G㒯Gᤣᐷሻ. EBM

∳⚯G⚯ᠣඇⅷG დ✘⚛G ሻG ᛔ❘⛏G ❧┧G ௗヷ㒯ඇG ♛㓋⁷, EBM⚛G⡓┋⤛G‘⚓ឳG╃ඇඇሻᇫG╇ೃG‘⚯G⛓ឳG㍃㒿㒯╃G⛋⛋G㓠♛⛧ᐻ⚯G㕨‘G⛧☧⚓ឳG⛋☀፯ᇫGⓨ‘⚛G㌋ⓓG㒯ᇫG⛋ሻ.14)

14) Faulkner(2010) PSA EBM RCTs , �‘ �’RCT(Super T)

, , EBM PSA

.

G

⛋ᶛᐳG G●, ⒟㕬∴G●Gᯟ╄G (2004), ே⡨≃⚯㒰, ⒛ⷋ⒛.

ᦫᑫⷓ▌❗ᯛG (2011.10.21), PSA ௗ G⮃დᛗ/ೄဋ┧G PSA ௗ GຄG㒛◫㒯ሻ.

ᦫᑫⷓ㍃⸻⇻G (2012.5.23), USPSTF, PSA ௗ ┧G "D ᑈൠ" 㒯⤗ᤣGდᛗ⚗G╃❛.

㉿㈏ᤄG☫∳·⛧ႎG☣㉜る, ╇㒰ಧGᶛᄿ⚯㒰╇ೃ⃣Gᯟ╄G (2010),

Dr. Patrick Walsh⚯G❛ᤔ⁷⒫⚓ឳょG⒛ᇫGᯬ, ╇㒰ಧGⳳ㉧.

㈏ᤃ※G൏ᤇ㒷㑛, ∷∐ⅯGᯟ╄G (2001), ⚯㒰დG❳ឳG⛔ඇ, ᨏ⚣.

㒯ⰄG (2010),  ❛⡓⚯☧ⶰ⚗Gᶛ㒰❘⛏ୗ? ♛㔯G⁴⚯Gდ✘⚛G ㄌ㓋G ᱏG  ❛⡓⚯G ☧ⶰ⚯G �‘㓀ᤃ₈�’, 㒰ඇⅷ㒰╇ೃ, ❳G 10G 2㖏, pp. 143-174.

㔟⁴G (2009), ே⡨≃G ோ⚯ᠣ❳ጛ⚯G 㖬ᤔ, 㒳⚯ 㕨㗣⤗, ❳G G 52 G 10㖏, pp. 934-935.

Amstrong, N. & Eborall, H. (2012), �“The Sociology of Medical

Screening: Past, Present & Future�”, in Amstrong, E. &

Eborall, H. eds., The Sociology of Medical Screening: Critical

Perspectives, New Directions, pp. 1-16, Oxford: Wiley-Blackwell.

Barett,, K. & Raffensperger, C. (1999), �“Precautionary Science�”, in

Raffensperger, C. & Tickner, J. eds., Protecting Public Health &

the Environment: Implementing the Precautionary Principle, pp.

106-122, Washington, DC: Island Press.

Barry, M. (2009), "Screening for Prostate Cancer: the Controversy that

Refuses to Die", The New England Journal of Medicine 360, pp.

1351-1354.

Brawley, O. (1997), "Prostate Carcinoma Incidence & Patient Mortality:

the Effects of Screening & Early Detection", Cancer 80,

pp.1857-1863.

(2009), "Prostate Cancer Screening: Is This a Teachable

Moment?", Journal of the National Cancer Institute 101, pp.

1295-1296.

Brown, N. & Webster, A. (2004), New Medical Technologies & Society:

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The PSA Testing Debate in the U.S and Flexible Evidence-Based Medicine

Hyun, Jae Hwan

The global diffusion of Evidence-Based Medicine (EBM) is changing the landscape of medicine and the healthcare system. STS scholars have shown how EBM works when put into practice. In continuing to add to the literature of previous scholars, this paper traces the historical process and debate over Prostate-Specific Antigen (PSA) testing as an early screening test for prostate cancer in the U.S. This study will reveal that both pros and cons of the testing using EBM as a crucial resources of the debate, and in the process both �‘flexibly�’ interpret and mobilize the hierarchy of scientific evidence for EBM despite the fact the hierarchy is imagined to being scientific criteria that is rigid. Furthermore, this paper will argue that this phenomenon, for which EBM currently seems to support the cons side of PSA screening, was constructed in the context of appraisal of the value 'quality of life' in the EBM system. This case study proposes that those who study the debate of medical technology in the EBM era should contextualize and analyze EBM as part of this debate rather than simply taking EBM for granted.

Key termsEvidence-based Medicine (EBM), Prostate-Specific Antigen (PSA), Diagnostic and screening Test, Quality of Life, Medicine in Practice