Oh Chung-Uk, Kang Hyekyung
Department of Nursing, Kangwon National University, Dogye-eup, Samcheok-si 25949, Gangwon-do, Republic of Korea.
Department of Nursing, Joongbu University, Chubu-myeon, Geumsan-gun 32713, Chungcheongnam-do, Republic of Korea.
Healthcare (Basel). 2025 Jun 9;13(12):1381. doi: 10.3390/healthcare13121381.
Prostate cancer's prevalence is rapidly increasing in Korea, with incidence rates rising by over 13% annually since 2017 according to the Korea Central Cancer Registry, highlighting the need for effective early detection strategies. This study systematically reviews the benefits and harms of PSA-based prostate cancer screening, focusing on its clinical effectiveness and public health implications.
Following PRISMA 2020 guidelines, we searched five databases (PubMed, Embase, Cochrane Library, Google Scholar, and KMbase) for studies from 2014 to 2024. The eligible studies included RCTs, cohort studies, meta-analyses, and guidelines. Risk of bias was assessed using the Cochrane tool. We synthesized our findings narratively due to their methodological heterogeneity.
Sixteen studies were included. PSA screening reduced prostate-cancer-specific mortality by 20-31%, as reported in multiple randomized controlled trials, such as ERSPC and ProScreen, among men aged 55-69, but showed minimal impact on all-cause mortality. Advanced tools such as MRI and multi-biomarker models, which were implemented in several included studies, enhanced diagnostic accuracy. The potential harms included overdiagnosis, overtreatment, and psychological distress. Community-based education and shared decision-making, inferred from observational and implementation studies, improved participation and equity in screening.
PSA-based screening offers modest mortality benefits but carries the risk of overdiagnosis. Precision diagnostics and risk-stratified strategies improve screening outcomes. Public health approaches, particularly those led by nurses and community health workers, are essential to promoting informed, equitable screening decisions.
韩国前列腺癌的患病率正在迅速上升，根据韩国中央癌症登记处的数据，自2017年以来发病率每年上升超过13%，这凸显了有效早期检测策略的必要性。本研究系统回顾了基于前列腺特异性抗原（PSA）的前列腺癌筛查的益处和危害，重点关注其临床有效性和对公共卫生的影响。
遵循PRISMA 2020指南，我们在五个数据库（PubMed、Embase、Cochrane图书馆、谷歌学术和KMbase）中检索了2014年至2024年的研究。符合条件的研究包括随机对照试验、队列研究、荟萃分析和指南。使用Cochrane工具评估偏倚风险。由于方法学的异质性，我们对研究结果进行了叙述性综合。
纳入了16项研究。如ERSPC和ProScreen等多项随机对照试验报告，在55至69岁的男性中，PSA筛查可使前列腺癌特异性死亡率降低20%至31%，但对全因死亡率的影响最小。在一些纳入研究中采用的MRI和多生物标志物模型等先进工具提高了诊断准确性。潜在危害包括过度诊断、过度治疗和心理困扰。从观察性研究和实施研究中推断，基于社区的教育和共同决策改善了筛查的参与度和公平性。
基于PSA的筛查有适度的死亡率益处，但存在过度诊断的风险。精准诊断和风险分层策略可改善筛查结果。公共卫生方法，特别是由护士和社区卫生工作者主导的方法，对于促进明智、公平的筛查决策至关重要。
