目前尚不清楚停止对老年男性进行前列腺癌 (PCa) 筛查的最佳时机，并且仍存在争议。 为了评估之前接受过基于前列腺特异性抗原 (PSA) 筛查的老年男性的前列腺癌特异性死亡率 (PCSM)，以确定那些可能从持续筛查中受益的人。共有 7052 名男性参加了欧洲前列腺癌筛查随机研究鹿特丹部分的筛查部门，在接受前列腺癌筛查后最后一次筛查时年龄为 70-74 岁最多包括三轮筛查但未诊断出 PCa。评估了 85 岁之前 PCSM 的累积发病率。此外，还进行了竞争风险回归来评估 PCSM 的潜在预测因素。中位随访时间为 16 年。到 85 岁，所有男性中 PCSM 的累积发病率为 0.54%（95% 置信区间 [CI]：0.40-0.70），PSA <2 ng/的男性为 0.11%（95% CI：0.05-0.27） ml，PSA 2-3 ng/ml 的男性为 0.85%（95% CI：0.47-1.5），PSA ≥ 6.5 ng/ml 且既往无良性活检的男性为 6.8%（95% CI：3.1-15） 。 PSA（亚分布风险比 [sHR]：2.0；95% CI：1.7-2.3）、既往良性前列腺活检（sHR：0.41；95% CI：0.23-0.72）和高血压（sHR：0.48；95% CI：0.25） -0.91) 与 PCSM 显着相关。70-74 岁的男性，如果之前接受过基于 PSA 的筛查，但没有得到 PCa 诊断，那么到 85 岁时死于 PCa 的风险非常低。这些数据表明，对于 PSA <3.0 ng/ml 或既往进行过良性前列腺活检的男性，可以停止筛查。如果预期寿命超过 10 岁，PSA 水平较高且之前未进行活检的人可能会考虑继续筛查。这项研究表明，参加前列腺癌筛查试验的男性，如果没有被诊断出患有前列腺癌，死于前列腺癌的风险非常低74 岁之前罹患前列腺癌。版权所有 © 2023 作者。由 Elsevier B.V. 出版。保留所有权利。

The optimal timing for discontinuing screening of prostate cancer (PCa) in elderly men is currently not known and remains debated.To assess prostate cancer-specific mortality (PCSM) in elderly men who previously underwent prostate-specific antigen (PSA)-based screening and to identify those who may benefit from continued screening.A total of 7052 men, who participated in the screening arm of the Rotterdam section of the European Randomized Study of Screening for Prostate Cancer and were aged 70-74 yr at their last screening visit after undergoing a maximum of three screening rounds without being diagnosed with PCa, were included.The cumulative incidence of PCSM by the age of 85 yr was assessed. Additionally, a competing risk regression was performed to assess the potential predictors of PCSM.The median follow-up was 16 yr. The cumulative incidence of PCSM by the age of 85 yr was 0.54% (95% confidence interval [CI]: 0.40-0.70) in all men, 0.11% (95% CI: 0.05-0.27) in men with PSA <2 ng/ml, 0.85% (95% CI: 0.47-1.5) in men with PSA 2-3 ng/ml, and 6.8% (95% CI: 3.1-15) in men with PSA ≥6.5 ng/ml and no previous benign biopsy. PSA (subdistribution hazard ratio [sHR]: 2.0; 95% CI: 1.7-2.3), previous benign prostate biopsy (sHR: 0.41; 95% CI: 0.23-0.72), and hypertension (sHR: 0.48; 95% CI: 0.25-0.91) were significantly associated with PCSM.Men aged 70-74 yr who have previously undergone PSA-based screening without receiving a PCa diagnosis have a very low risk of dying from PCa by the age of 85 yr. These data suggest that screening may be discontinued in men with PSA <3.0 ng/ml or previous benign prostate biopsies. Those with higher PSA levels and no prior biopsies may consider continued screening if life expectancy exceeds 10 yr.This study shows that men who participated in a prostate cancer screening trial have a very low risk of dying from prostate cancer if they have not been diagnosed with prostate cancer by the age of 74 yr.Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.