Carlsson Sigrid V, Roobol Monique J
aMemorial Sloan Kettering Cancer Center, Department of Surgery and Epidemiology & Biostatistics, New York, USA bInstitute of Clinical Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden cDepartment of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands.
Curr Opin Urol. 2016 Sep;26(5):447-58. doi: 10.1097/MOU.0000000000000321.
The aim of this review was to highlight important articles in the field of prostate cancer screening published during 2015 and early 2016. Four major areas were identified for the purpose: screening strategies, post-United States Preventive Services Task Force (USPSTF) 2011-2012, screening trends/patterns, and shared decision making.
Several studies furthered the evidence that screening reduces the risk of metastasis and death from prostate cancer. Multiplex screening strategies are of proven benefit; genetics and MRI need further evaluation. Prostate-specific antigen (PSA) screening rates declined in men above age of 50 years, as did the overall prostate cancer incidence following the USPSTF 2011-2012 recommendation against PSA. The consequences of declining screening rates will become apparent in the next few years. More research is needed to identify the most optimal approach to engage in, and implement, an effective shared decision-making in clinical practice.
Data emerging in 2015 provided evidence on the question of how best to screen and brought more steps in the right direction of 'next-generation prostate cancer screening'. Screening is an ongoing process in all men regardless of whether or not they might benefit from early detection and treatment. After the USPSTF 2011-2012 recommendation, the rates of PSA testing are declining; however, this decline is observed in all men and not solely in those who will not benefit from the screening. The long-term effect of this recommendation might not be as anticipated. More studies are needed on how to implement the best available evidence on who, and when, to screen in clinical practice.
本综述旨在突出2015年至2016年初发表的前列腺癌筛查领域的重要文章。为此确定了四个主要领域:筛查策略、美国预防服务工作组(USPSTF)2011 - 2012年后、筛查趋势/模式以及共同决策。
多项研究进一步证明筛查可降低前列腺癌转移和死亡风险。多重筛查策略已证实有益;遗传学和磁共振成像(MRI)需要进一步评估。50岁以上男性的前列腺特异性抗原(PSA)筛查率下降,2011 - 2012年USPSTF建议不进行PSA筛查后,前列腺癌总体发病率也下降。筛查率下降的后果将在未来几年显现。需要更多研究来确定在临床实践中进行并实施有效共同决策的最佳方法。
2015年出现的数据为如何最佳筛查提供了证据,并朝着“下一代前列腺癌筛查”的正确方向迈进了更多步伐。筛查是所有男性的一个持续过程,无论他们是否可能从早期检测和治疗中受益。2011 - 2012年USPSTF建议后,PSA检测率在下降;然而,这种下降在所有男性中都有观察到,而不仅仅是那些不会从筛查中受益的男性。该建议的长期影响可能并不如预期。需要更多关于如何在临床实践中对谁以及何时进行筛查实施最佳现有证据的研究。