Alberts Arnout R, Schoots Ivo G, Roobol Monique J
Department of Urology, Erasmus University Medical Center, Rotterdam, the Netherlands.
Department of Radiology, Erasmus University Medical Center, Rotterdam, the Netherlands.
Int J Urol. 2015 Jun;22(6):524-32. doi: 10.1111/iju.12750. Epub 2015 Apr 6.
Prostate-specific antigen-based prostate cancer screening remains a controversial topic. Up to now, there is worldwide consensus on the statement that the harms of population-based screening, mainly as a result of overdiagnosis (the detection of clinically insignificant tumors that would have never caused any symptoms), outweigh the benefits. However, worldwide opportunistic screening takes place on a wide scale. The European Randomized Study of Screening for Prostate Cancer showed a reduction in prostate cancer mortality through prostate-specific antigen based-screening. These population-based data need to be individualized in order to avoid screening in those who cannot benefit and start screening in those who will. For now, lacking a more optimal screening approach, screening should only be started after the process of shared decision-making. The focus of future research is the reduction of unnecessary testing and overdiagnosis by further research to better biomarkers and the value of the multiparametric magnetic resonance imaging, potentially combined in already existing prostate-specific antigen-based multivariate risk prediction models.
基于前列腺特异性抗原的前列腺癌筛查仍然是一个有争议的话题。到目前为止，对于基于人群的筛查危害大于益处这一说法，全球已达成共识，其危害主要源于过度诊断（检测出临床上无意义的肿瘤，这些肿瘤本不会引起任何症状）。然而，全球范围内的机会性筛查仍广泛存在。欧洲前列腺癌筛查随机研究表明，基于前列腺特异性抗原的筛查可降低前列腺癌死亡率。为避免对无法受益的人群进行筛查，并让能受益的人群开始筛查，这些基于人群的数据需要个体化。目前，由于缺乏更优化的筛查方法，筛查应仅在共同决策过程之后开始。未来研究的重点是通过进一步研究更好的生物标志物以及多参数磁共振成像的价值（可能结合现有的基于前列腺特异性抗原的多变量风险预测模型）来减少不必要的检测和过度诊断。
