【摘要】 目的:分析基于前列腺特异性抗原(prostate-specific antigen, PSA)的前列腺癌筛查人群的临床特征，探索优化特定人群筛查策略的关键方向。方法:将2020年11月—2021年10月期间接受PSA筛查的≥50岁男性纳入筛查组(22 118人),PSA>4 ng/mL者进一步完善直肠指检、多参数前列腺MRI和(或)核医学检查以及穿刺活检；同期门诊确诊患者为临床组。比较2组患者年龄、PSA水平、下尿路症状、Gleason评分、TNM分期、治疗方法。结果:筛查组确诊前列腺癌206例；临床组共纳入170例新确诊的前列腺癌患者。筛查组前列腺癌检出率为0.93%(206/22 118),中位年龄73岁，87.9%为局限性前列腺癌。筛查组伴下尿路症状(P=0.003)、远处转移(P=0.023)显著低于临床组。>70岁患者中位PSA更高(15.01 ng/mL vs 11.89 ng/mL,P=0.003),且淋巴结转移前列腺癌比例(P=0.038)更高，而接受治愈性治疗比例更低(P<0.001)。伴下尿路症状亚组分析中，筛查组淋巴结转移(P=0.043)、远处转移(P=0.009)风险明显低于临床组。结论:年龄是侵袭性前列腺癌的独立危险因素。针对伴下尿路症状人群的筛查可显著降低晚期前列腺癌比例。基于年龄分层、精准影像诊断及区域性多维度干预策略，可优化筛查成本效益与临床获益。更多还原

【Abstract】 Objective: To analyze the clinical characteristics of prostate cancer screening population based on PSA, and to explore the key direction of optimizing the screening strategy of specific population. Methods: Males aged ≥50 years who underwent PSA screening between November 2020 and October 2021 were included in the screening group(n=22 118). Those with PSA >4 ng/mL further completed digital rectal examination, multi-parameter prostate MRI, and/or nuclear medicine examination and biopsy; the patients diagnosed in the outpatient department during the same period were in the clinical group. The age, PSA level, lower urinary tract symptoms, Gleason score, TNM stage and management approach were compared between the two groups. Results: Two hundred and six cases of prostate cancer were diagnosed in the screening group. A total of 170 newly diagnosed prostate cancer patients were included in the clinical group. The detection rate of prostate cancer in the screening group was 206/22 118(0.93%). The patient’s median age was 73 years old, and 87.9% were localized prostate cancer. Lower urinary tract symptoms(P=0.003) and distant metastasis(P=0.023) were significantly lower in the screening group than in the clinical group. The median PSA was higher in patients over 70 years old(15.01 ng/mL vs 11.89 ng/mL, P=0.003), and the lymph node metastasis(P=0.038) was higher, while the proportion of patients receiving curative treatment was lower(P<0.001). In the subgroup with lower urinary tract symptoms, the risk of lymph node metastasis(P=0.043) and distant metastasis(P=0.009) in the screening group was significantly lower than that in the clinical group. Conclusion: Age is an independent risk factor in invasive prostate cancer. Screening for people with lower urinary tract symptoms can significantly reduce the proportion of advanced prostate cancer. Based on age stratification, accurate imaging diagnosis and regional multi-dimensional intervention strategies, cost-effectiveness of screening and clinical benefits can be optimized.更多还原