澳大利亚更新前列腺癌PSA检测指南

澳大利亚发布了十年来首次更新的前列腺癌PSA检测指南，建议50至69岁的男性每两年考虑进行一次PSA血液检测1。根据新指南，45至49岁男性可进行一次基线检测1。

指南明确了PSA检测的效能与风险：检测预防约千分之二的前列腺癌死亡和约千分之五的转移性癌症1。在澳大利亚，每200名50岁男性中约有1人会被诊断出前列腺癌，但死亡率仅为千分之181。

新指南同时指出了PSA筛查的局限性。根据一项15年试验，通过一次性筛查发现的癌症中约六分之一被过度诊断1。为降低过度诊断风险，指南推荐在治疗前采用主动监测而非立即治疗低危癌症1。此外，MRI检查可避免28%的患者进行活检1，PSA的临界值设定为3.0纳克/毫升1。

Australia has released its first update in a decade to prostate cancer screening recommendations, advising men aged 50 to 69 to consider undergoing a PSA blood test every two years 1. The updated guidance also recommends men aged 45 to 49 receive a single baseline test 1.

The new guidelines outline both the benefits and risks of PSA testing. The screening can prevent approximately 2 in 1,000 prostate cancer deaths and approximately 5 in 1,000 metastatic cancer cases 1. However, the recommendations acknowledge significant drawbacks, including false positives, overdiagnosis, and false negatives 1. Among cancers detected through a single screening round, approximately one-sixth were estimated to be overdiagnosed based on a 15-year trial 1. The PSA threshold used is 3.0 nanograms per milliliter (ng/mL) 1.

For men with detected abnormalities, the guidelines recommend active monitoring rather than immediate treatment for low-risk cancers 1. Additionally, MRI examinations can avoid the need for biopsy in 28 percent of patients 1. In Australia, approximately 1 in 200 men aged 50 will be diagnosed with prostate cancer, though the mortality rate remains only 18 per 1,000 1.