Background

Recommendations against prostate-specific antigen (PSA) testing in 2012 have increased advanced-stage diagnosis and prostate cancer–specific mortality rates.

Objective

To present the position of the European Association of Urology (EAU) in 2021 and provide recommendations for the use of PSA testing as part of a risk-adapted strategy for the early detection of prostate cancer.

Evidence acquisition

The authors combined their review of relevant literature, including the EAU prostate cancer guidelines 2021 update, with their own knowledge to provide an expert opinion, representing the EAU’s position in 2021.

Evidence synthesis

The EAU has developed a risk-adapted early prostate cancer detection strategy for well-informed men based on PSA testing, risk calculators, and multiparametric magnetic resonance imaging, which can differentiate significant from insignificant prostate cancer. This approach largely avoids the overdiagnosis/overtreatment of men unlikely to experience disease-related symptoms during their lifetime and facilitates an early diagnosis of men with significant cancer to receive active treatment. It also reduces advanced-stage diagnosis, thereby potentially reducing prostate cancer–specific mortality and improving quality of life. Education is required among urologists, general practitioners, radiologists, policy makers, and healthy men, including endorsement by the European Commission to adapt the European Council’s screening recommendations in its 2022 plan and requests to individual countries for its incorporation into national cancer plans.

Conclusions

This risk-adapted approach for the early detection of prostate cancer will reverse current unfavourable trends and ultimately save lives.

Patient summary

The European Association of Urology has developed a patient information leaflet and algorithm for the early diagnosis of prostate cancer. It can identify men who do not need magnetic resonance imaging or a biopsy and those who would not show any symptoms versus those with more aggressive disease who require further tests/treatment. We need to raise awareness of this algorithm to ensure that all well-informed men at risk of significant prostate cancer are offered a prostate-specific antigen test.

中文翻译：

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前列腺特异性抗原检测作为适应风险的前列腺癌早期检测策略的一部分：欧洲泌尿外科协会 2021 年立场和建议

背景

2012 年针对前列腺特异性抗原 (PSA) 检测的建议增加了晚期诊断和前列腺癌特异性死亡率。

客观的

介绍欧洲泌尿外科协会 (EAU) 在 2021 年的立场，并就使用 PSA 检测作为早期发现前列腺癌风险适应策略的一部分提供建议。

取证

作者将他们对相关文献的回顾（包括 EAU 前列腺癌指南 2021 更新）与他们自己的知识相结合，以提供专家意见，代表 EAU 在 2021 年的立场。

证据综合

EAU 基于 PSA 检测、风险计算器和多参数磁共振成像，为消息灵通的男性制定了风险适应的早期前列腺癌检测策略，该策略可以区分显着和无关紧要的前列腺癌。这种方法在很大程度上避免了男性在其一生中不太可能出现疾病相关症状的过度诊断/过度治疗，并有助于早期诊断患有严重癌症的男性以接受积极治疗。它还减少了晚期诊断，从而有可能降低前列腺癌特异性死亡率并提高生活质量。泌尿科医生、全科医生、放射科医生、政策制定者和健康男性需要接受教育，

结论

这种用于早期发现前列腺癌的风险适应方法将扭转当前的不利趋势并最终挽救生命。

患者总结

欧洲泌尿外科协会开发了一份用于前列腺癌早期诊断的患者信息传单和算法。它可以识别不需要磁共振成像或活检的男性，以及那些不会出现任何症状的男性，以及那些需要进一步检查/治疗的更具侵袭性的疾病。我们需要提高对该算法的认识，以确保为所有有重大前列腺癌风险的消息灵通的男性提供前列腺特异性抗原检测。