Schröder Fritz H, Roobol Monique J, Bangma Chris H
Erasmus MC, afd. Urologie, Rotterdam.
Ned Tijdschr Geneeskd. 2015;159:A8677.
The recent publication of updated results from the European randomised study of screening for prostate cancer (ERSPC) with a median 13-year follow-up confirms significant relative and absolute reductions in prostate cancer mortality. In spite of existing guidelines, Dutch men and professionals remain uncertain about the use of PSA testing. The data now available will be helpful in reaching informed decisions. In men aged 55-69 years, the relative mortality reduction remained similar at 21%; the absolute reduction increased from 0.9 to 1.28 fewer deaths/1000 men screened. This translates into much improved figures needing to be invited for screening and diagnosed, at 781 and 27 (1410 and 48 in 2009). As expected, overall mortality does not differ between the arms of the study. The main downside of PSA-driven screening remains the diagnosis of non-life-threatening cancers (overdiagnosis) by screening, at a frequency of about 40%, which can be reduced by use of the Prostate Cancer Risk Calculator. Current data support the present guideline which recommends informed decision-making, taking into account the advantages and potential damage caused by PSA testing.
欧洲前列腺癌筛查随机研究（ERSPC）最新结果的近期发表，该研究中位随访13年，证实前列腺癌死亡率有显著的相对和绝对降低。尽管现有指南，但荷兰男性和专业人士对前列腺特异性抗原（PSA）检测的使用仍不确定。现有的数据将有助于做出明智的决策。在55 - 69岁男性中，相对死亡率降低仍相似，为21%；绝对降低从每1000名接受筛查的男性中死亡0.9例增加到1.28例。这转化为需要邀请进行筛查和诊断的人数大幅改善，分别为781人和27人（2009年为1410人和48人）。正如预期的那样，研究各臂之间的总体死亡率没有差异。PSA驱动筛查的主要缺点仍然是通过筛查诊断出非危及生命的癌症（过度诊断），频率约为40%，可通过使用前列腺癌风险计算器来降低。当前数据支持现行指南，该指南建议在考虑PSA检测的益处和潜在损害的情况下做出明智的决策。
