Department of Urology, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands.
Nat Rev Urol. 2013 Jan;10(1):38-48. doi: 10.1038/nrurol.2012.225. Epub 2012 Dec 18.
Screening for prostate cancer is a controversial topic within the field of urology. The US Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial did not demonstrate any difference in prostate-cancer-related mortality rates between men screened annually rather than on an 'opportunistic' basis. However, in the world's largest trial to date--the European Randomised Study of Screening for Prostate Cancer--screening every 2-4 years was associated with a 21% reduction in prostate-cancer-related mortality rate after 11 years. Citing the uncertain ratio between potential harm and potential benefit, the US Preventive Services Task Force recently recommended against serum PSA screening. Although this ratio has yet to be elucidated, PSA testing--and early tumour detection--is undoubtedly beneficial for some individuals. Instead of adopting a 'one size fits all' approach, physicians are likely to perform personalized risk assessment to minimize the risk of negative consequences, such as anxiety, unnecessary testing and biopsies, overdiagnosis, and overtreatment. The PSA test needs to be combined with other predictive factors or be used in a more thoughtful way to identify men at risk of symptomatic or life-threatening cancer, without overdiagnosing indolent disease. A risk-adapted approach is needed, whereby PSA testing is tailored to individual risk.
前列腺癌筛查在泌尿外科领域是一个颇具争议的话题。美国前列腺、肺、结直肠和卵巢癌筛查试验并未显示出每年筛查与机会性筛查相比，前列腺癌相关死亡率有任何差异。然而，在迄今为止全球规模最大的前列腺癌筛查随机研究——欧洲前列腺癌筛查研究中，每 2-4 年进行一次筛查，11 年后前列腺癌相关死亡率降低了 21%。美国预防服务工作组最近援引潜在危害与潜在益处之间不确定的比率，建议反对进行血清 PSA 筛查。尽管尚未阐明这一比率，但 PSA 检测——以及早期肿瘤检测——对某些人无疑是有益的。医生可能会进行个性化风险评估，而不是采用一刀切的方法，以尽量减少焦虑、不必要的检测和活检、过度诊断和过度治疗等负面后果的风险。PSA 检测需要与其他预测因素结合使用，或者以更具思考性的方式使用，以识别有症状或危及生命的癌症风险的男性，而不会过度诊断惰性疾病。需要采取一种风险适应的方法，根据个体风险定制 PSA 检测。
