The Johns Hopkins University School of Medicine, Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins Hospital, Baltimore, MD, USA.
BJU Int. 2013 Sep;112(5):543-7. doi: 10.1111/bju.12318.
To review the process and rationale for the American Urological Association (AUA) guideline on prostate cancer detection. The AUA guideline on detection of prostate cancer involved a systematic literature review of >300 studies that evaluated outcomes important to patients (prostate cancer, incidence/mortality, health-related quality of life, diagnostic accuracy and harms of testing). A multidisciplinary panel interpreted the evidence and formulated statements to assist the urologist and the asymptomatic average-risk man in decision-making about prostate cancer detection. Other than prostate-specific antigen (PSA)-based prostate cancer screening, there was no evidence to address the outcomes of interest to patients. The strongest evidence that benefits may outweigh harms was in men aged 55-69 years undergoing PSA-based screening. This led the panel to recommend shared decision-making for these men at average risk, but recommend against routine screening for other age groups at average risk. Further, to reduce the harms associated with screening (false positive tests, over diagnosis, over treatment), the panel recommended against annual screening for those who choose to be screened. A panel under the auspices of the AUA recommended shared decision-making for the average risk asymptomatic man aged 55-69 years considering PSA-based screening for prostate cancer detection.
回顾美国泌尿外科学会 (AUA) 前列腺癌检测指南的制定过程和原理。AUA 前列腺癌检测指南涉及对评估患者相关结局（前列腺癌、发病率/死亡率、健康相关生活质量、诊断准确性和检测危害）的 300 多项研究进行系统文献回顾。一个多学科小组解释了证据并制定了陈述，以帮助泌尿科医生和无症状的一般风险男性在前列腺癌检测方面做出决策。除了基于前列腺特异性抗原 (PSA) 的前列腺癌筛查外，没有证据可以解决患者关注的结局问题。在年龄 55-69 岁接受 PSA 筛查的男性中，获益可能超过危害的证据最强。这导致专家组建议对这些处于一般风险的男性进行共同决策，但不建议对其他处于一般风险的年龄组进行常规筛查。此外，为了降低筛查相关的危害（假阳性检测、过度诊断、过度治疗），专家组建议对于选择筛查的人，反对每年进行筛查。在 AUA 的主持下，一个专家组建议对年龄在 55-69 岁、考虑基于 PSA 的前列腺癌检测筛查的无症状一般风险男性进行共同决策。
