J Natl Compr Canc Netw. 2004 May;2(3):190-207. doi: 10.6004/jnccn.2004.0018.
Since guidelines for the early detection of prostate cancer were developed by the ACS in the early 1990s, many variants of the total PSA assay have been introduced in attempts to increase the sensitivity of screening programs (cancer detection) while maintaining specificity (elimination of unnecessary biopsies). Again, it is important to note that the NCCN guidelines recommend a method by which individuals and their physicians can use these new methods rationally for the early detection of prostate cancer. These guidelines are not designed to provide an argument for the use of early detection programs for prostate cancer. Rather, they are meant to provide a vehicle by which early detection efforts can be practiced in an evidence-based, systematic fashion in patients who choose to participate in such programs. The NCCN guidelines incorporate many new validated findings in addition to the DRE and tPSA test. These new factors include percent-free PSA, PSA velocity, complexed PSA, biopsy pathology, and TRUS-guided biopsy techniques. The panel will re-examine the clinical utility of these new modalities annually, and the guidelines will be modified accordingly. In addition, future iterations of these guidelines may incorporate new serum markers currently undergoing clinical investigation. The goal of the NCCN and this guideline panel in updating these algorithms is that they will assist men and clinicians choose a program of early detection for prostate cancer to make decisions regarding the need for prostate biopsy. Any clinician who uses these guidelines is expected to exercise independent medical judgment in the context of the individual clinical circumstances to determine the patient's need for prostate biopsy. These guidelines will continue to evolve as the field of prostate cancer advances.
自20世纪90年代初美国癌症协会（ACS）制定前列腺癌早期检测指南以来，已推出了总前列腺特异性抗原（PSA）检测的多种变体，试图在保持特异性（避免不必要的活检）的同时提高筛查项目（癌症检测）的敏感性。同样，重要的是要注意，美国国立综合癌症网络（NCCN）指南推荐了一种方法，通过该方法个人及其医生可以合理地使用这些新方法进行前列腺癌的早期检测。这些指南并非旨在为使用前列腺癌早期检测项目提供论据。相反，它们旨在提供一种手段，通过这种手段，可以以循证、系统的方式在选择参与此类项目的患者中开展早期检测工作。除了直肠指检（DRE）和总PSA检测外，NCCN指南纳入了许多新的经过验证的发现。这些新因素包括游离PSA百分比、PSA速率、复合PSA、活检病理以及经直肠超声（TRUS）引导的活检技术。该小组将每年重新审视这些新模式的临床实用性，并相应修改指南。此外，这些指南的未来版本可能会纳入目前正在进行临床研究的新血清标志物。NCCN和该指南小组更新这些算法的目标是，它们将帮助男性和临床医生选择前列腺癌早期检测方案，以便就前列腺活检的必要性做出决策。任何使用这些指南的临床医生都应在个体临床情况的背景下运用独立的医学判断，以确定患者对前列腺活检的需求。随着前列腺癌领域的发展，这些指南将不断演变。
