Van Poppel Hendrik, Roobol Monique J, Chapple Christopher R, Catto James W F, N'Dow James, Sønksen Jens, Stenzl Arnulf, Wirth Manfred
Department of Urology, University Hospitals Leuven, Leuven, Belgium.
Department of Urology, Erasmus University Medical Centre Cancer Institute, Rotterdam, The Netherlands.
Eur Urol. 2021 Dec;80(6):703-711. doi: 10.1016/j.eururo.2021.07.024. Epub 2021 Aug 15.
Recommendations against prostate-specific antigen (PSA) testing in 2012 have increased advanced-stage diagnosis and prostate cancer-specific mortality rates.
To present the position of the European Association of Urology (EAU) in 2021 and provide recommendations for the use of PSA testing as part of a risk-adapted strategy for the early detection of prostate cancer.
The authors combined their review of relevant literature, including the EAU prostate cancer guidelines 2021 update, with their own knowledge to provide an expert opinion, representing the EAU's position in 2021.
The EAU has developed a risk-adapted early prostate cancer detection strategy for well-informed men based on PSA testing, risk calculators, and multiparametric magnetic resonance imaging, which can differentiate significant from insignificant prostate cancer. This approach largely avoids the overdiagnosis/overtreatment of men unlikely to experience disease-related symptoms during their lifetime and facilitates an early diagnosis of men with significant cancer to receive active treatment. It also reduces advanced-stage diagnosis, thereby potentially reducing prostate cancer-specific mortality and improving quality of life. Education is required among urologists, general practitioners, radiologists, policy makers, and healthy men, including endorsement by the European Commission to adapt the European Council's screening recommendations in its 2022 plan and requests to individual countries for its incorporation into national cancer plans.
This risk-adapted approach for the early detection of prostate cancer will reverse current unfavourable trends and ultimately save lives.
The European Association of Urology has developed a patient information leaflet and algorithm for the early diagnosis of prostate cancer. It can identify men who do not need magnetic resonance imaging or a biopsy and those who would not show any symptoms versus those with more aggressive disease who require further tests/treatment. We need to raise awareness of this algorithm to ensure that all well-informed men at risk of significant prostate cancer are offered a prostate-specific antigen test.
2012年针对前列腺特异性抗原（PSA）检测的建议增加了晚期诊断率和前列腺癌特异性死亡率。
阐述欧洲泌尿外科学会（EAU）在2021年的立场，并就将PSA检测作为前列腺癌早期检测风险适应性策略的一部分提供建议。
作者结合对相关文献的回顾，包括2021年EAU前列腺癌指南更新，以及自身知识，提供专家意见，代表EAU在2021年的立场。
EAU基于PSA检测、风险计算器和多参数磁共振成像，为信息充分的男性制定了一种风险适应性早期前列腺癌检测策略，该策略可区分有意义和无意义的前列腺癌。这种方法在很大程度上避免了对那些在一生中不太可能出现与疾病相关症状的男性进行过度诊断/过度治疗，并有助于对患有严重癌症的男性进行早期诊断以便接受积极治疗。它还减少了晚期诊断，从而有可能降低前列腺癌特异性死亡率并改善生活质量。泌尿外科医生、全科医生、放射科医生、政策制定者和健康男性都需要接受教育，包括获得欧盟委员会的认可，以便在其2022年计划中调整欧洲理事会的筛查建议，并要求各个国家将其纳入国家癌症计划。
这种风险适应性前列腺癌早期检测方法将扭转当前不利趋势并最终挽救生命。
欧洲泌尿外科学会已制定了一份患者信息手册和前列腺癌早期诊断算法。它可以识别出不需要磁共振成像或活检的男性，以及那些不会出现任何症状的男性，与那些患有侵袭性更强疾病需要进一步检查/治疗的男性。我们需要提高对该算法的认识，以确保所有有患严重前列腺癌风险且信息充分的男性都能接受前列腺特异性抗原检测。
