Cancer Center, Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands.
Cancer Institute, Erasmus University Medical Centre, Rotterdam, The Netherlands.
BJU Int. 2024 Jul;134(1):31-42. doi: 10.1111/bju.16311. Epub 2024 Mar 12.
Population-based organised repeated screening for prostate cancer has been found to reduce disease-specific mortality, but with substantial overdiagnosis leading to overtreatment. Although only very few countries have implemented a screening programme on a national level, individual prostate-specific antigen (PSA) testing is common. This opportunistic testing may have little favourable impact, while stressing the side-effects. The classic early detection protocols as were state-of-the-art in the 1990s applied a PSA and digital rectal examination threshold for sextant systematic prostate biopsy, with a fixed interval for re-testing, and limited indication for expectant management. In the three decades since these trials were started, different important improvements have become available in the cascade of screening, indication for biopsy, and treatment. The main developed aspects include: better identification of individuals at risk (using early/baseline PSA, family history, and/or genetic profile), individualised re-testing interval, optimised and individualised starting and stopping age, with gradual invitation at a fixed age rather than invitation of a wider range of age groups, risk stratification for biopsy (using PSA density, risk calculator, magnetic resonance imaging, serum and urine biomarkers, or combinations/sequences), targeted biopsy, transperineal biopsy approach, active surveillance for low-risk prostate cancer, and improved staging of disease. All these developments are suggested to decrease the side-effects of screening, while at least maintaining the advantages, but Level 1 evidence is lacking. The knowledge gained and new developments on early detection are being tested in different prospective screening trials throughout Europe. In addition, the European Union-funded PRostate cancer Awareness and Initiative for Screening in the European Union (PRAISE-U) project will compare and evaluate different screening pilots throughout Europe. Implementation and sustainability will also be addressed. Modern screening approaches may reduce the burden of the second most frequent cause of cancer-related death in European males, while minimising side-effects. Also, less efficacious opportunistic early detection may be indirectly reduced.
基于人群的有组织的前列腺癌重复筛查已被证明可以降低疾病特异性死亡率，但也存在大量过度诊断导致过度治疗的情况。尽管只有极少数国家在全国范围内实施了筛查计划，但个别前列腺特异性抗原（PSA）检测很常见。这种机会性检测可能没有什么有利影响，反而会带来压力和副作用。20 世纪 90 年代处于前沿水平的经典早期检测方案应用 PSA 和数字直肠检查阈值对六个部位进行系统前列腺活检，设定重新检测的固定间隔，并对期待管理有限制。自这些试验开始的三十年来，在筛查、活检指征和治疗方面都出现了不同的重要改进。主要发展方面包括：更好地识别高危人群（使用早期/基线 PSA、家族史和/或遗传特征）、个性化重新检测间隔、优化和个性化起始和停止年龄，逐渐邀请固定年龄的人群，而不是邀请更广泛的年龄组、活检风险分层（使用 PSA 密度、风险计算器、磁共振成像、血清和尿液生物标志物，或组合/序列）、靶向活检、经会阴活检方法、低危前列腺癌的主动监测，以及疾病分期的改善。所有这些发展都旨在减少筛查的副作用，同时至少保持其优势，但缺乏 1 级证据。欧洲各地正在不同的前瞻性筛查试验中测试这些新进展。此外，欧盟资助的前列腺癌认知和欧盟筛查倡议（PRAISE-U）项目将比较和评估欧洲各地的不同筛查试点。实施和可持续性也将得到解决。现代筛查方法可能会降低欧洲男性第二大常见癌症相关死亡原因的负担，同时将副作用降至最低。此外，不太有效的机会性早期检测也可能会间接减少。
