Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
Finnish Cancer Registry, Helsinki, Finland.
Int J Cancer. 2023 Feb 15;152(4):672-678. doi: 10.1002/ijc.34274. Epub 2022 Sep 15.
Prostate-specific antigen (PSA)-based screening for prostate cancer (PCa) can reduce PCa mortality, but also involves overdetection of low-risk disease with potential adverse effects. We evaluated PCa incidence among men with PSA below 3 ng/mL and no PCa diagnosis at the first screening round of the Finnish Randomized Study of Screening for PCa. Follow-up started at the first screening attendance and ended at PCa diagnosis, emigration, death or the common closing date (December 2016), whichever came first. Cox regression analysis was used to estimate hazard ratios and their confidence intervals (CI). Among men with PSA <3 ng/mL, cumulative PCa incidence was 9.1% after 17.6 years median follow-up. Cumulative incidence was 3.6% among men with baseline PSA 0 to 0.99 ng/mL, 11.5% in those with PSA 1.0 to 1.99 ng/mL and 25.7% among men with PSA 2 to 2.99 ng/mL (hazard ratio 9.0, 95% CI: 7.9-10.2 for the latter). The differences by PSA level were most striking for low-risk disease based on Gleason score and EAU risk group. PSA values <1 ng/mL indicate a very low 20-year risk, while at PSA 2 to 2.99 ng/mL risks are materially higher, with 4- to 5-fold risk for aggressive disease. Using risk-stratification and appropriate rescreening intervals will reduce screening intensity and overdetection. Using cumulative incidence of clinically significant PCa (csPCa) as the criterion, rescreening intervals could range from approximately 3 years for men with initial PSA 2 to 2.99 ng/mL, 6 years for men with PSA 1 to 1.99 ng/mL to 10 years for men with PSA <1 ng/mL.
基于前列腺特异性抗原（PSA）的前列腺癌（PCa）筛查可以降低 PCa 死亡率，但也会导致低危疾病的过度检出，从而产生潜在的不良影响。我们评估了芬兰前列腺癌筛查随机研究中首次筛查轮次 PSA<3ng/mL 且无 PCa 诊断的男性中的 PCa 发病率。随访从首次筛查就诊开始，至 PCa 诊断、移民、死亡或共同截止日期（2016 年 12 月）结束，以先发生者为准。使用 Cox 回归分析来估计风险比及其置信区间（CI）。在 PSA<3ng/mL 的男性中，中位随访 17.6 年后 PCa 的累积发病率为 9.1%。在基线 PSA 为 0 至 0.99ng/mL 的男性中，累积发病率为 3.6%，在 PSA 为 1.0 至 1.99ng/mL 的男性中为 11.5%，在 PSA 为 2 至 2.99ng/mL 的男性中为 25.7%（后者的风险比为 9.0，95%CI：7.9-10.2）。PSA 水平之间的差异在基于 Gleason 评分和 EAU 风险组的低危疾病方面最为明显。PSA 值<1ng/mL 表明 20 年风险非常低，而 PSA 为 2 至 2.99ng/mL 时风险明显更高，侵袭性疾病的风险增加 4-5 倍。通过风险分层和适当的重新筛查间隔，可以降低筛查强度和过度检出。使用临床显著前列腺癌（csPCa）的累积发病率作为标准，重新筛查间隔时间可为 PSA 初始值为 2 至 2.99ng/mL 的男性约 3 年，PSA 为 1 至 1.99ng/mL 的男性约 6 年，PSA<1ng/mL 的男性约 10 年。
