欧洲泌尿科协会的指南建议基于首次前列腺特异性抗原（PSA）水平和年龄采用基于风险的前列腺癌筛查策略。在一项人群筛查试验中（每2-4年重复筛查），分析首次PSA水平对前列腺癌（PCa）检测和PCa特定死亡率（PCSM）的影响。在欧洲随机前列腺癌筛查研究（ERSPC）试验中，我们评估了25589名年龄在55-59岁的男性，16898名年龄在60-64岁的男性和12936名年龄在65-69岁的男性，在16年的随访中至少参加了一次筛查（筛查组：每2-4年重复PSA测试，PSA升高时进行活检；对照组：不主动提供筛查）。我们评估了任何PCa和临床意义（cs）PCa（Gleason≥7）的现值概率。进行Cox比例危险回归以评估基线PSA与PCSM之间的关联是否适用于所有年龄组。计算Lorenz曲线以评估60-61岁男性基线PSA与PCSM之间的关联性。在所有年龄组中，基线PSA可以指导重复筛查间隔的决策。对于年龄在55-69岁的男性，基线PSA <1.0 ng/ml是延迟或停止进一步筛查的强有力指标。在前列腺癌筛查中，可以使用患者的基线PSA（前列腺特异性抗原）水平来指导决定何时重复筛查。根据当前知识使用PSA测试有助于减轻前列腺癌的负担。这些结果可能并不适用于机会式筛查或当代临床实践。版权所有©2023作者。由Elsevier B.V.出版。保留所有权利。

The European Association of Urology guidelines recommend a risk-based strategy for prostate cancer screening based on the first prostate-specific antigen (PSA) level and age.To analyze the impact of the first PSA level on prostate cancer (PCa) detection and PCa-specific mortality (PCSM) in a population-based screening trial (repeat screening every 2-4 yr).We evaluated 25589 men aged 55-59 yr, 16898 men aged 60-64 yr, and 12936 men aged 65-69 yr who attended at least one screening visit in the European Randomized Study of Screening for Prostate Cancer (ERSPC) trial (screening arm: repeat PSA testing every 2-4 yr and biopsy in cases with elevated PSA; control arm: no active screening offered) during 16-yr follow-up (FU).We assessed the actuarial probability for any PCa and for clinically significant (cs)PCa (Gleason ≥7). Cox proportional-hazards regression was performed to assess whether the association between baseline PSA and PCSM was comparable for all age groups. A Lorenz curve was computed to assess the association between baseline PSA and PCSM for men aged 60-61 yr.The overall actuarial probability at 16 yr ranged from 12% to 16% for any PCa and from 3.7% to 5.7% for csPCa across the age groups. The actuarial probability of csPCa at 16 yr ranged from 1.2-1.5% for men with PSA <1.0 ng/ml to 13.3-13.8% for men with PSA ≥3.0 ng/ml. The association between baseline PSA and PCSM differed marginally among the three age groups. A Lorenz curve for men aged 60-61 yr showed that 92% of lethal PCa cases occurred among those with PSA above the median (1.21 ng/ml). In addition, for men initially screened at age 60-61 yr with baseline PSA <2 ng/ml, further continuation of screening is unlikely to be beneficial after the age of 68-70 yr if PSA is still <2 ng/ml. No case of PCSM emerged in the subsequent 8 yr (up to age 76-78 yr). A limitation is that these results may not be generalizable to an opportunistic screening setting or to contemporary clinical practice.In all age groups, baseline PSA can guide decisions on the repeat screening interval. Baseline PSA of <1.0 ng/ml for men aged 55-69 yr is a strong indicator to delay or stop further screening.In prostate cancer screening, the patient's baseline PSA (prostate-specific antigen) level can be used to guide decisions on when to repeat screening. The PSA test when used according to current knowledge is valuable in helping to reduce the burden of prostate cancer.Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.