Bratt Ola, Auvinen Anssi, Arnsrud Godtman Rebecka, Hellström Mikael, Hugosson Jonas, Lilja Hans, Wallström Jonas, Roobol Monique J
Department of Urology, Institute of Clinical Sciences, University of Gothenburg, Sahlgrenska Academy, Goteborg, Sweden.
Department of Urology, Sahlgrenska University Hospital, Goteborg, Sweden.
BMJ Oncol. 2023 Apr 20;2(1):e000039. doi: 10.1136/bmjonc-2023-000039. eCollection 2023.
Long-term screening with serum prostate-specific antigen (PSA) and systematic prostate biopsies can reduce prostate cancer mortality but leads to unacceptable overdiagnosis. Over the past decade, diagnostic methods have improved and the indolent nature of low-grade prostate cancer has been established. These advances now enable more selective detection of potentially lethal prostate cancer. This non-systematic review summarises relevant diagnostic advances, previous and ongoing screening trials, healthcare policies and important remaining knowledge gaps. Evidence synthesis and conclusions: The strong association between low serum PSA values and minimal long-term risk of prostate cancer death allows for adjusting screening intervals. Use of risk calculators, biomarkers and MRI to select men with a raised PSA value for biopsy and lesion-targeting rather than systematic prostate biopsies reduce the detection of low-grade cancer and thereby overdiagnosis. These improvements recently led the European Union to recommend its member states to evaluate the feasibility and effectiveness of organised screening programmes for prostate cancer. Nonetheless, important knowledge gaps remain such as the performance of modern diagnostic methods in long-term screening programmes and their impact on mortality. The knowledge gaps are currently being addressed in three large randomised screening trials. Population-based pilot programmes will contribute critical practical experience.
长期使用血清前列腺特异性抗原（PSA）进行筛查以及系统性前列腺活检可降低前列腺癌死亡率，但会导致不可接受的过度诊断。在过去十年中，诊断方法有所改进，低级别前列腺癌的惰性本质已得到证实。这些进展现在能够更有选择性地检测潜在致命性前列腺癌。这篇非系统性综述总结了相关诊断进展、既往和正在进行的筛查试验、医疗政策以及重要的尚存知识空白。证据综合与结论：低血清PSA值与前列腺癌死亡的最低长期风险之间的强关联使得可以调整筛查间隔。使用风险计算器、生物标志物和磁共振成像（MRI）来选择PSA值升高的男性进行活检和病变靶向活检，而非系统性前列腺活检，可减少低级别癌症的检测，从而减少过度诊断。这些改进最近促使欧盟建议其成员国评估前列腺癌有组织筛查项目的可行性和有效性。尽管如此，仍存在重要的知识空白，例如现代诊断方法在长期筛查项目中的表现及其对死亡率的影响。目前正在三项大型随机筛查试验中解决这些知识空白。基于人群的试点项目将提供关键的实践经验。
