Bristol Medical School, 1980University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
J Med Screen. 2022 Dec;29(4):268-271. doi: 10.1177/09691413221119238. Epub 2022 Sep 4.
To summarise and compare the key recommendations on prostate-specific antigen (PSA)-based screening for prostate cancer, and so highlight where more evidence is required to facilitate consistent recommendations.
The Medline database and websites of 18 national screening organisations and professional associations were searched between January 2010 and November 2020 to identify screening guidelines published in English, considering recent clinical trials.
Population-based PSA testing of asymptomatic men is not widely recommended. Guidelines emphasize shared patient-clinician decision making. For 'average-risk' men choosing to be screened, the recommended age varies from 50-55 to 70 years, alongside consideration of life expectancy (ranging from 7-15 years). Screening intervals, when specified, are biennial (most common), annual, or determined from baseline PSA. The earliest age for screening high-risk men (frequently defined as of African descent or with a family history of prostate cancer) is 40 years, but recommendations often defer to clinical judgement.
Population screening of asymptomatic men is not widely recommended. Instead, balancing the potential harms and benefits of PSA testing is endorsed. Variation between guidelines stems from differing interpretations of key trials and could lead to clinician-dependent screening views. The development of clinical decision aids and international consensus on guidelines may help reduce national and international variation on how men are counselled.
总结和比较基于前列腺特异性抗原（PSA）的前列腺癌筛查的关键建议，以突出需要更多证据的地方，从而促进一致建议的制定。
从 2010 年 1 月至 2020 年 11 月，在 Medline 数据库和 18 个国家筛查组织和专业协会的网站上搜索英文发表的筛查指南，考虑了最近的临床试验。
不广泛推荐对无症状男性进行基于人群的 PSA 检测。指南强调了患者-临床医生共同决策。对于选择接受筛查的“一般风险”男性，建议的年龄从 50-55 岁到 70 岁不等，同时还考虑了预期寿命（7-15 年）。当指定筛查间隔时，通常为两年一次（最常见）、每年一次或根据基线 PSA 确定。筛查高风险男性（通常定义为非洲裔或有前列腺癌家族史）的最早年龄为 40 岁，但建议通常取决于临床判断。
不广泛推荐对无症状男性进行人群筛查。相反，赞成平衡 PSA 检测的潜在危害和益处。指南之间的差异源于对关键试验的不同解释，可能导致临床医生对筛查的看法存在差异。开发临床决策辅助工具和国际指南共识可能有助于减少各国在男性咨询方面的差异。
