European Study of Prostate Cancer Screening - 23-Year Follow-up.

Because deaths from prostate cancer are expected to rise worldwide owing to increased life expectancy and population growth, a final analysis of the long-term outcomes of prostate cancer screening is essential to understanding the benefits and harms of PSA testing.

由于预期全球前列腺癌死亡人数将因预期寿命延长和人口增长而上升，对前列腺癌筛查的长期结果进行最终分析对于理解PSA检测的利弊至关重要。

Methods

We updated the findings from ERSPC, a multicenter, randomized study conducted across eight European countries with a focus on a predefined core age group of 162,236 men who were 55 to 69 years of age at the time of randomization.

我们更新了欧洲前列腺癌筛查随机研究（ERSPC）的发现，该研究是一个在八个欧洲国家开展的多中心、随机研究，重点关注了一个预先定义的核心年龄组，共有162,236名在随机分组时年龄在55至69岁之间的男性。

Participants were randomly assigned to the screening group and offered repeated PSA testing or to the control group and not invited for screening.

参与者被随机分配到筛查组，提供重复的前列腺特异性抗原（PSA）测试，或者被分配到对照组，不被邀请进行筛查。

The primary outcome was prostate cancer mortality.

主要结果是前列腺癌的死亡率。

Results

After a median follow-up of 23 years, prostate cancer mortality was 13% lower in the screening group (rate ratio, 0.87; 95% confidence interval[CI], 0.80 to 0.95), and the absolute risk reduction was 0.22% (95% CI, 0.10 to 0.34).

经过中位随访23年后，筛查组的前列腺癌死亡率降低了13%（率比，0.87；95%置信区间[CI]，0.80至0.95），绝对风险降低为0.22%（95% CI，0.10至0.34）。

The cumulative incidenceof prostate cancer was higher in the screening group than in the control group (rate ratio, 1.30; 95% CI, 1.26 to 1.33).

在筛查组中，前列腺癌的累积发病率高于对照组（比率比，1.30；95%置信区间，1.26至1.33）。

At a median of 23 years of follow-up, one death from prostate cancer was prevented for every 456 men (95% CI, 306 to 943) who were invited for screening, and one death from prostate cancer was averted for every 12 men (95% CI, 8 to 26) in whom prostate cancer was diagnosed, as compared with one death from prostate cancer prevented for every 628 men (95% CI, 419 to 1481) and one death averted for every 18 men (95% CI, 12 to 45) at 16 years of follow-up.

在中位随访23年时，每邀请456名接受筛查的男性中，就预防了一例前列腺癌死亡（95%置信区间，306至943），而在被诊断出前列腺癌的每12名男性中，就避免了一例前列腺癌死亡（95%置信区间，8至26），与之相比，在16年的随访中，每628名接受筛查的男性中预防了一例前列腺癌死亡（95%置信区间，419至1481），以及每18名被诊断出前列腺癌的男性中避免了一例前列腺癌死亡（95%置信区间，12至45）。

Conclusions

Long-term follow-up confirms a sustained reduction in deaths from prostate cancer with PSA testing, alongside an improved harm-benefit ratio.

长期随访证实，前列腺特异性抗原（PSA）检测可显著降低前列腺癌死亡率，并改善了风险-效益比。

Future screening strategies should adopt risk-based approaches to minimize overdiagnosis while maintaining clinical benefits.

未来的筛查策略应采用基于风险的方法，以最小化过度诊断的同时保持临床效益。

(Funded by the Dutch Cancer Society and others; ERSPC ISRCTN registry number, ISRCTN49127736.).

(由荷兰癌症协会和其他机构资助; ERSPC ISRCTN注册号, ISRCTN49127736.)。