Abstract：
BACKGROUND: In the United States, Black men are at highest risk for being diagnosed with and dying from prostate cancer. Given this disparity, we examined relevant data to establish clinical prostate-specific antigen (PSA) screening guidelines for Black men in the United States.
METHODS: A comprehensive literature search identified 1848 unique publications for screening. Of those screened, 287 studies were selected for full-text review, and 264 were considered relevant and form the basis for these guidelines. The numbers were reported according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines.
RESULTS: Three randomized controlled trials provided Level 1 evidence that regular PSA screening of men 50 to 74 years of age of average risk reduced metastasis and prostate cancer death at 16 to 22 years of follow-up. The best available evidence specifically for Black men comes from observational and modeling studies that consider age to obtain a baseline PSA, frequency of testing, and age when screening should end. Cohort studies suggest that discussions about baseline PSA testing between Black men and their clinicians should begin in the early 40s, and data from modeling studies indicate prostate cancer develops 3 to 9 years earlier in Black men compared with non-Black men. Lowering the age for baseline PSA testing to 40 to 45 years of age from 50 to 55 years of age, followed by regular screening until 70 years of age (informed by PSA values and health factors), could reduce prostate cancer mortality in Black men (approximately 30% relative risk reduction) without substantially increasing overdiagnosis.
CONCLUSIONS: These guidelines recommend that Black men should obtain information about PSA screening for prostate cancer. Among Black men who elect screening, baseline PSA testing should occur between ages 40 and 45. Depending on PSA value and health status, annual screening should be strongly considered. (Supported by the Prostate Cancer Foundation.).
METHODS: A comprehensive literature search identified 1848 unique publications for screening. Of those screened, 287 studies were selected for full-text review, and 264 were considered relevant and form the basis for these guidelines. The numbers were reported according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines.
RESULTS: Three randomized controlled trials provided Level 1 evidence that regular PSA screening of men 50 to 74 years of age of average risk reduced metastasis and prostate cancer death at 16 to 22 years of follow-up. The best available evidence specifically for Black men comes from observational and modeling studies that consider age to obtain a baseline PSA, frequency of testing, and age when screening should end. Cohort studies suggest that discussions about baseline PSA testing between Black men and their clinicians should begin in the early 40s, and data from modeling studies indicate prostate cancer develops 3 to 9 years earlier in Black men compared with non-Black men. Lowering the age for baseline PSA testing to 40 to 45 years of age from 50 to 55 years of age, followed by regular screening until 70 years of age (informed by PSA values and health factors), could reduce prostate cancer mortality in Black men (approximately 30% relative risk reduction) without substantially increasing overdiagnosis.
CONCLUSIONS: These guidelines recommend that Black men should obtain information about PSA screening for prostate cancer. Among Black men who elect screening, baseline PSA testing should occur between ages 40 and 45. Depending on PSA value and health status, annual screening should be strongly considered. (Supported by the Prostate Cancer Foundation.).
摘要：
背景：在美国，黑人男性被诊断出患有前列腺癌并死于前列腺癌的风险最高。鉴于这种差距,我们检查了相关数据,以建立针对美国黑人男性的临床前列腺特异性抗原(PSA)筛查指南.
方法：一项全面的文献检索确定了1848种独特的筛选出版物。在那些被筛查的人中，287项研究被选中进行全文回顾，264人被认为是相关的，构成了这些指南的基础。这些数字是根据PRISMA（系统审查和荟萃分析的首选报告项目）指南报告的。
结果：三项随机对照试验提供了1级证据，表明对50至74岁平均风险的男性进行常规PSA筛查可减少16至22年随访时前列腺癌的转移和死亡。针对黑人男性的最佳可用证据来自观察和建模研究，这些研究考虑了获得基线PSA的年龄，测试频率，以及筛查结束时的年龄。队列研究表明，关于黑人和他们的临床医生之间的基线PSA测试的讨论应该在40年代初开始，来自建模研究的数据表明，与非黑人男性相比，黑人男性的前列腺癌发展要早3到9年。将基线PSA检测的年龄从50到55岁降低到40到45岁，然后定期筛查直到70岁（根据PSA值和健康因素），可以降低黑人男性的前列腺癌死亡率（相对风险降低约30％），而不会显着增加过度诊断。
结论：这些指南建议黑人男性应该获得有关PSA筛查前列腺癌的信息。在选择筛选的黑人中，基线PSA检测应在40至45岁之间进行。根据PSA值和健康状况，应强烈考虑每年的筛查。（由前列腺癌基金会支持。).
方法：一项全面的文献检索确定了1848种独特的筛选出版物。在那些被筛查的人中，287项研究被选中进行全文回顾，264人被认为是相关的，构成了这些指南的基础。这些数字是根据PRISMA（系统审查和荟萃分析的首选报告项目）指南报告的。
结果：三项随机对照试验提供了1级证据，表明对50至74岁平均风险的男性进行常规PSA筛查可减少16至22年随访时前列腺癌的转移和死亡。针对黑人男性的最佳可用证据来自观察和建模研究，这些研究考虑了获得基线PSA的年龄，测试频率，以及筛查结束时的年龄。队列研究表明，关于黑人和他们的临床医生之间的基线PSA测试的讨论应该在40年代初开始，来自建模研究的数据表明，与非黑人男性相比，黑人男性的前列腺癌发展要早3到9年。将基线PSA检测的年龄从50到55岁降低到40到45岁，然后定期筛查直到70岁（根据PSA值和健康因素），可以降低黑人男性的前列腺癌死亡率（相对风险降低约30％），而不会显着增加过度诊断。
结论：这些指南建议黑人男性应该获得有关PSA筛查前列腺癌的信息。在选择筛选的黑人中，基线PSA检测应在40至45岁之间进行。根据PSA值和健康状况，应强烈考虑每年的筛查。（由前列腺癌基金会支持。).
