摘要目的 探索针对前列腺癌高危人群进行前列腺癌精准筛查的方法和意义.方法 2017年4月至2018年8月间,对来自上海13个社区服务站和上海、江苏3个筛查基地的2159例高危男性进行了基于血清前列腺特异性抗原(PSA)检测的前列腺癌筛查.PSA≥4.0μg/L者建议行前列腺穿刺活检.收集流行病学相关资料,分析其与前列腺癌发病风险的相关性.结果 PSA异常者271例(12.6％),中位PSA值9.1μg/L(4.0～25.0μg/L).其中57例PSA异常者接受了前列腺穿刺活检,穿刺意愿率为21.0％.34例经穿刺证实为前列腺癌,穿刺阳性率59.6％,总体前列腺癌检出率1.57％.来自于筛查基地和来自于社区服务站的两组人群PSA水平异常率和穿刺阳性率差异均无统计学意义(P=0.578和0.735).PSA水平异常与高龄(OR:2.63;95％CI:1.84～3.75,P<0.001)和有前列腺炎病史(OR:2.02;95％CI:1.55～2.63,P<0.001)等因素有关,前列腺癌发病风险与高龄(OR:4.04;95％CI:1.71～9.59,P=0.002)、服用降脂药物有关(OR:3.09;95％CI:1.25～7.69,P=0.015).随着年龄的增长,PSA水平异常和前列腺癌发生率都逐渐升高.结论 针对高危人群的前列腺癌精准筛查是可行且有效的.年龄和他汀类药物使用可能与中国人群前列腺癌发病风险增加相关.进一步推广在高危人群中的前列腺癌筛查将有望改善我国前列腺癌分期偏晚、总体预后差的现状.

abstractsObjective The Chinese Anti-Cancer Association Genitourinary Cancer Committee Prostate Cancer Working Group released Consensus of prostate cancer (PCa) screening in 2017. This program aims to evaluate the methods and significance of prostate cancer precision screening in high risk population. Methods A total of 2159 eligible males enrolled from 13 community centers and 3 screening centers received PSA test from April 2017 to August 2018. Prostate-specific antigen (PSA) determination in serum with a cut-off of ≥4.0 ng / ml was the main screening test and indication for biopsy. The interviewer-administered questionnaire covered demographic characteristics and environmental exposure factors. The associations between these factors and prostate cancer risk were determined by multivariable unconditional logistic regression models. Results Altogether, 271 cases (12.6％) had a confirmed PSA increase ≥ 4.0μg/L (median 9.1, range 4.0-25.0). Subsequently, 57 subjects (21.0％) out of the 271 PSA-suspicious men underwent prostate biopsy, and 34 (59.6％) were confirmed as prostate cancer. Until now, the overall prostate cancer incidence in the first screening round was1.57％. There were no statistical differences in the distributions of PSA-suspicious and prostate cancer incidence between community centers and screening centers (P=0.578 and 0.735). Age (OR: 2.63; 95％CI: 1.84-3.75, P<0.001) and chronic prostatitis history (OR: 2.02; 95％CI: 1.55-2.63, P<0.001) were significantly associated with PSA level. After adjustment for these factors, older age (OR: 4.04; 95％CI: 1.71-9.59, P=0.002) and statins use (OR:3.09; 95％CI: 1.25-7.69, P=0.015) were associated with an elevated risk of PCa. Conclusions It is of substantial significance to screen prostate cancer in high risk population. Both community centers and&nbsp;screening centers methods are effective. Although largely underestimated, the incidence of PCa in the targeted Chinese population is higher than expected. Older men have a high risk of harboring PCa. Our study suggests a decreased risk of PCa in men with statins use. Prostate Cancer Precision Screening is promising to improve prostate cancer survival in China.