Baccaglini Willy, Cathelineau Xavier, Araújo Glina Felipe Placo, Medina Luis G, Sotelo Rene, Carneiro Arie, Sanchez-Salas Rafael
Department of Urology. L'Institut Mutualiste Montsouris. Université Paris Descartes. Paris. France. Discipline of Urology. ABC Medical School. Santo Andre. SP. Brazil. University of Southern California. Keck School of Medicine. Institute of Urology. Los Angeles. CA. US.
Department of Urology. L'Institut Mutualiste Montsouris. Université Paris Descartes. Paris. France.
Arch Esp Urol. 2019 Mar;72(2):98-103.
Prostate cancer (PCa) is the most common non-skin malignancy among men world-wide. PCa incidence is higher among African American (AA) menin comparison to the white population. Men with a previous history of PCa in first-line relatives carry also an increased risk for this disease. The incidence of PCa diminished in United States (US) since the publication in 2012 of US Preventive Service Task Force (USPSTF), in which PCa screening was bestowed with a grade D of recommendation. Nonetheless, locally advanced andmetastatic disease rates increased notably. In 2018, the USPSTF drop back in their statement against PCa screening and recommended this to be a shared-decision between men 55-69 years old and their physicians.A side-by-side evaluation methodology of the three trials included in USPSTF review was performed. The high intensity screening modality and the lower contamination rate in the control arm found in the ERSPC trial justify theearlier splitting in the cumulative mortality curves between the screening and control arm when contrasted with the CAP and PCLO trials presented. We aim to perform an objective and critical review of the current practice on prostate cancer screening, regarding its limitations and when the physician should offer a shared-decision process screening based on PSA.The controversy over PSA screening has not ended despite unequivocal evidence that it saves lives. Although the USPSTF's 2017 new draft is a step in the right direction, there is more progress to be made concerning the identification of patients harboring high-risk tumors and, consequently, die of PCa. PSA baseline may lead us to differentiate properly patients at high-risk from those under risk of overdiagnosis and overtreatment. It is well established that mpMRI has come to help us in the diagnosis of PCa and in the identification of clinically significanttumors. Finally, studies ongoing on biomarkers may assist us to improve our understanding about this frequent malignancy.
前列腺癌（PCa）是全球男性中最常见的非皮肤恶性肿瘤。与白人相比，非裔美国（AA）男性的PCa发病率更高。一线亲属有PCa病史的男性患此病的风险也会增加。自2012年美国预防服务工作组（USPSTF）发布报告以来，美国的PCa发病率有所下降，该报告中PCa筛查的推荐等级为D级。尽管如此，局部晚期和转移性疾病的发病率显著上升。2018年，USPSTF在其反对PCa筛查的声明中有所退缩，并建议55至69岁的男性与其医生共同做出决定。对USPSTF审查中纳入的三项试验进行了并列评估方法。与CAP和PCLO试验相比，ERSPC试验中发现的高强度筛查方式以及对照组中较低的污染率，证明了筛查组和对照组之间累积死亡率曲线的早期分离是合理的。我们旨在对当前前列腺癌筛查的实践进行客观和批判性的审查，探讨其局限性以及医生何时应基于前列腺特异性抗原（PSA）提供共同决策过程的筛查。尽管有明确证据表明PSA筛查能挽救生命，但关于PSA筛查的争议仍未结束。尽管USPSTF 2017年的新草案朝着正确方向迈出了一步，但在识别携带高危肿瘤并因此死于PCa的患者方面仍有更多工作要做。PSA基线可能有助于我们正确区分高危患者与那些有过度诊断和过度治疗风险的患者。磁共振成像（mpMRI）已被广泛用于帮助我们诊断PCa和识别具有临床意义的肿瘤。最后，正在进行的生物标志物研究可能有助于我们加深对这种常见恶性肿瘤的理解。
