Department of Public Health, Erasmus Medical Center, Wytemaweg 80, CN Rotterdam, 3015, The Netherlands.
Department of Urology, Erasmus Medical Center, Wytemaweg 80, CN Rotterdam, 3015, The Netherlands.
Int J Cancer. 2018 Feb 15;142(4):741-746. doi: 10.1002/ijc.31102. Epub 2017 Oct 25.
The European Randomised Study of Screening for Prostate Cancer (ERSPC) showed that Prostate-Specific Antigen (PSA) based screening results in a significant prostate cancer mortality reduction. Although there are concerns on overdiagnosis and overtreatment, it has been shown that the benefits can outweigh the harms if screening is stopped in older ages to prevent overdiagnosis. A limited screening program (for example screening at ages 55-59 years), including active surveillance for men with low-risk tumors, can even be cost-saving, compared with testing in an opportunistic setting in the wrong ages, as currently in Europe. Further improvements are expected in the use of active surveillance and in discrimination between indolent and significant disease due to new biomarkers and magnetic resonance imaging. However, these future developments are no reason to postpone feasibility studies of high-quality PSA screening and reduce opportunistic testing at old ages.
欧洲前列腺癌筛查随机研究（ERSPC）表明，基于前列腺特异性抗原（PSA）的筛查可显著降低前列腺癌死亡率。尽管人们对过度诊断和过度治疗存在担忧，但如果在老年时停止筛查以预防过度诊断，那么其益处可能大于危害。与在当前欧洲不合适的年龄段进行机会性检测相比，有限的筛查计划（例如在 55-59 岁年龄段进行筛查），包括对低危肿瘤患者进行主动监测，甚至可以节省成本。由于新的生物标志物和磁共振成像的应用，主动监测的使用和对惰性与显著疾病的区分方面有望进一步改善。然而，这些未来的发展并不能成为推迟高质量 PSA 筛查可行性研究和减少老年机会性检测的理由。
