American Urological Association Education and Research, Inc., Linthicum, Maryland, USA.
J Urol. 2013 Aug;190(2):419-26. doi: 10.1016/j.juro.2013.04.119. Epub 2013 May 6.
The guideline purpose is to provide the urologist with a framework for the early detection of prostate cancer in asymptomatic average risk men.
A systematic review was conducted and summarized evidence derived from over 300 studies that addressed the predefined outcomes of interest (prostate cancer incidence/mortality, quality of life, diagnostic accuracy and harms of testing). In addition to the quality of evidence, the panel considered values and preferences expressed in a clinical setting (patient-physician dyad) rather than having a public health perspective. Guideline statements were organized by age group in years (age <40; 40 to 54; 55 to 69; ≥ 70).
Except prostate specific antigen-based prostate cancer screening, there was minimal evidence to assess the outcomes of interest for other tests. The quality of evidence for the benefits of screening was moderate, and evidence for harm was high for men age 55 to 69 years. For men outside this age range, evidence was lacking for benefit, but the harms of screening, including over diagnosis and overtreatment, remained. Modeled data suggested that a screening interval of two years or more may be preferred to reduce the harms of screening.
The Panel recommended shared decision-making for men age 55 to 69 years considering PSA-based screening, a target age group for whom benefits may outweigh harms. Outside this age range, PSA-based screening as a routine could not be recommended based on the available evidence.
本指南的目的是为泌尿科医生提供一个框架，用于在无症状的一般风险男性中早期发现前列腺癌。
进行了系统评价，并总结了来自 300 多项研究的证据，这些研究涉及预先确定的感兴趣的结局（前列腺癌发病率/死亡率、生活质量、诊断准确性和检测危害）。除了证据质量外，专家组还考虑了临床环境（医患二人组）中表达的价值观和偏好，而不是从公共卫生角度考虑。指南陈述按年龄组（<40 岁；40-54 岁；55-69 岁；≥70 岁）进行组织。
除基于前列腺特异性抗原的前列腺癌筛查外，几乎没有证据可以评估其他检测的感兴趣结局。筛查益处的证据质量为中等，55-69 岁男性筛查的危害证据为高。对于年龄在该范围之外的男性，缺乏益处的证据，但筛查的危害，包括过度诊断和过度治疗，仍然存在。模拟数据表明，可能更倾向于选择两年或更长的筛查间隔，以减少筛查的危害。
专家组建议对于考虑基于 PSA 的筛查的 55-69 岁男性进行共同决策，这是一个获益可能超过危害的目标年龄组。在这个年龄范围之外，基于 PSA 的筛查作为常规筛查不能基于现有证据推荐。
