【AUA指南】攝護腺癌的早期檢測(Early detection of prostate cancer)

Guideline statements

1. The Panel recommends against PSA screening in men under age 40 years. (Recommendation; Evidence Strength Grade C)

1. 不建議對40歲以下男性進行PSA篩查。（建議；證據強度：C級）

· In this age group there is a low prevalence of clinically detectable prostate cancer, no evidence demonstrating benefit of screening and likely the same harms of screening as in other age groups.

· 在這一年齡組中，臨床可檢測的攝護腺癌發病率低，沒有證據表明篩查有益，並且其帶來的危害可能與其他年齡組的相同。

2. The Panel does not recommend routine screening in men between ages 40 to 54 years at average risk. (Recommendation; Evidence Strength Grade C)

2. 不建議對處於平均風險的、40-54歲的男性進行常規篩查。（建議；證據強度：C級）

· For men younger than age 55 years at higher risk, decisions regarding prostate cancer screening should be individualized. Those at higher risk may include men of African American race; and those with a family history of metastatic or lethal adenocarcinomas (e.g., prostate, male and female breast cancer, ovarian, pancreatic) spanning multiple generations, affecting multiple first-degree relatives, and that developed at younger ages.

· 對具有較高風險的、小於55歲的男性進行攝護腺癌篩查應做到個體化。較高風險包括：非洲裔美國男性；轉移性或致死性腺癌（如：攝護腺癌、男性或女性乳腺癌、卵巢癌、胰腺癌）跨越多代的家族史、影響多個一級親屬以及在較低年齡發病。

3. For men ages 55 to 69 years the Panel recognizes that the decision to undergo PSA screening involves weighing the benefits of reducing the rate of metastatic prostate cancer and prevention of prostate cancer death against the known potential harms associated with screening and treatment. For this reason, the Panel strongly recommends shared decision-making for men age 55 to 69 years that are considering PSA screening, and proceeding based on a man』s values and preferences. (Standard; Evidence Strength Grade B)

3. 對55-69歲男性進行PSA篩查，應將降低轉移性攝護腺癌發生率和攝護腺癌死亡率的益處與篩查及治療帶來的已知潛在危害權衡後實施，並應兼顧男性的價值觀及偏好。（標準；證據強度：B級）

· The greatest benefit of screening appears to be in men ages 55 to 69 years.

· 55-69歲男性進行攝護腺癌篩查可獲得最大益處。

· Multiple approaches subsequent to a PSA test (e.g., urinary and serum biomarkers, imaging, risk calculators) are available for identifying men more likely to harbor a prostate cancer and/or one with an aggressive phenotype. The use of such tools can be considered in men with a suspicious PSA level to inform prostate biopsy decisions.

· 繼PSA檢查之後的多種方法（如：尿液和精液生物標誌物、影像學檢查、風險評估工具）可用於鑒別是否更易罹患攝護腺癌和（或）存在侵襲性表型。這些方法可應用在具有可疑PSA水準行攝護腺穿刺活檢的患者。

4. To reduce the harms of screening, a routine screening interval of two years or more may be preferred over annual screening in those men who have participated in shared decision-making and decided on screening. As compared to annual screening, it is expected that screening intervals of two years preserve the majority of the benefits and reduce overdiagnosis and false positives. (Option; Evidence Strength Grade C)

4. 為降低篩查帶來的危害，建議與患者共同決策後將篩查間期定為兩年或以上。與每年篩查相比，間隔兩年篩查保留了大部分益處並可減少過度診斷和誤診。（選擇；證據強度：C級）

· Additionally, intervals for rescreening can be individualized by a baseline PSA level.

· 此外，再次篩查的間隔時間可通過基線PSA水準個體化。

5. The Panel does not recommend routine PSA screening in men over age 70 years or any man with less than a 10 to 15 year life expectancy. (Recommendation; Evidence Strength Grade C)

5. 不建議常規對大於70歲或預期壽命小於10-15年的男性進行PSA篩查。（建議；證據強度：C級）

· Some men over age 70 years who are in excellent health may benefit from prostate cancer screening.

· 部分大於70歲、身體狀況良好的男性可能會在攝護腺癌篩查中獲益。

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