前期研究使用《欧洲前列腺癌筛查随机研究》（ERSPC）的11年跟踪数据和《微模拟筛查分析》（MISCAN）进行了前列腺特异性抗原（PSA）基于前列腺癌（PCa）筛查对生活年质量的影响的量化。ERSPC数据目前已成熟，跟踪时间为21年。通过长期、详细、经验性的ERSPC数据，提供PSA基于筛查对肿瘤特征和PCa治疗的影响的概述。选取从ERSPC鹿特丹中随机分配到PSA基于筛查（S）组或对照（C）组的男性。我们评估了PSA基于筛查对PCa诊断数、肿瘤特征、治疗以及疾病进展的累积发病率的影响。我们还评估了两组研究中肿瘤特征和治疗随时间的变化。在S组的PCa患者中，诊断有进展期肿瘤(T3/T4：12% vs 23%，相对风险[RR]=0.50；95%置信区间[CI]0.44-0.57)的患者较少，观察到较少的疾病进展，需要较少的次级治疗（30% vs 48%，RR=0.61；95% CI 0.57-0.66；P <0.001）和较少的姑息治疗（21% vs 55%，RR=0.38；95% CI 0.35-0.42）。但这是以过度诊断和增加局部治疗为代价的（例如，激素治疗：32% vs 14%；RR=2.18；95% CI 1.92-2.48）。随着时间推移，局部治疗的数量减少，而期望治疗策略增加。治疗的RR与MISCAN的略有不同。经过21年的跟踪，ERSPC的经验性数据显示，基于PSA的筛查减少了晚期PCa阶段、疾病进展和广泛治疗的发生，但以过度诊断和可能的过度治疗为代价。我们的数据显示，随着时间推移，局部治疗减少，期望治疗策略增加。基于前列腺特异性抗原的筛查减少了侵袭性前列腺癌所需的治疗次数，但以过度诊断和可能的过度治疗为代价。限制这些成本对于充分从前列腺癌筛查中获益至关重要。版权所有©2023 The Authors. Published by Elsevier B.V. All rights reserved.

Previous research quantified the effect of prostate-specific antigen (PSA)-based prostate cancer (PCa) screening on quality-adjusted life years using 11-yr follow-up data from the European Randomized Study of Screening for Prostate Cancer (ERSPC) extrapolated by the Microsimulation Screening Analysis (MISCAN). ERSPC data now matured to 21 yr of follow-up.To provide an overview of the effect of PSA-based screening on tumour characteristics and PCa treatment using long-term, detailed, empirical ERSPC data.Men were included from the ERSPC Rotterdam who were randomised to a PSA-based screening (S) or control (C) arm.We assessed the effects of PSA-based screening on the number of PCa diagnoses, tumour characteristics, treatments, and cumulative incidence of disease progression. We also evaluated the changes in tumour characteristics and treatments over time for both study arms.Among PCa patients in the S-arm, fewer patients were diagnosed with advanced tumour stages (T3/T4: 12% vs 23%; relative risk [RR] = 0.50; 95% confidence interval [CI] 0.44-0.57), less disease progression was observed, and less secondary treatment (30% vs 48%; RR = 0.61; 95% CI 0.57-0.66; p < 0.001) and less palliative treatment were needed (21% vs 55%; RR = 0.38; 95% CI 0.35-0.42) than among those in the C-arm. This was at the cost of overdiagnosis and increased local treatments (eg, radical prostatectomy: 32% vs 14%; RR = 2.18; 95% CI 1.92-2.48). Over time, the number of local treatments decreased, whereas expectant management strategies increased. The RRs of treatments were slightly different from those of the MISCAN.After 21 yr of follow-up, empirical data of the ERSPC showed that PSA-based screening reduces advanced PCa stages, disease progression, and extensive treatments at the cost of more overdiagnosis and probably more overtreatment. Our data showed reduced local treatments and increased expectant management strategies over time.Prostate-specific antigen-based screening reduces the number of invasive prostate cancer treatments needed, however, at the cost of more overdiagnosis and probably more overtreatment. Limiting these costs remains crucial to benefit optimally from prostate cancer screening.Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.