临床指南中对于前列腺特异性抗原（PSA）筛查的有效性尚未达成共识，尤其是对于老年人。 PSA 筛查的随机试验产生了不同的结果，部分原因是依从性存在差异，并且不太可能进行新的试验。我们的目标是评估年度 PSA 筛查对 67-84 岁医疗保险受益人前列腺癌 (PC) 死亡率的影响。这是一项大规模、基于人群的观察性研究，涉及两种筛查策略：年度 PSA 筛查和不定期筛查。筛选。我们使用了 537,599 名年龄在 67-84 岁的美国医疗保险 (2001-2008) 受益人的数据，他们的预期寿命良好，没有既往 PC，并且在基线前 2 年内没有进行 PSA 测试。我们估计了 8 年 PC 死亡率和发病率、PC 治疗方法以及 PSA 筛查的治疗并发症。在 67-74 岁的男性中，PSA 筛查与未筛查之间的 8 年 PC 死亡风险估计差异为 -2.3 （95% CI，-4.1 至 -1.1）每 1,000 名男性死亡（负风险差异有利于筛查）。 PSA 筛查下的治疗并发症比未筛查时更常见。在 75-84 岁的男性中，风险差异估计接近于零。我们的估计表明，根据传统统计标准，每年 PSA 筛查 8 年与 PC 死亡率降低高度一致，从每 1,000 名接受筛查的男性减少 4 例到 1 例。年龄67-74岁。与任何使用真实世界数据的研究一样，估计值可能会受到残留混杂因素的影响。

No consensus about the effectiveness of prostate-specific antigen (PSA) screening exists among clinical guidelines, especially for the elderly. Randomized trials of PSA screening have yielded different results, partly because of variations in adherence, and it is unlikely that new trials will be conducted. Our objective was to estimate the effect of annual PSA screening on prostate cancer (PC) mortality in Medicare beneficiaries age 67-84 years.This is a large-scale, population-based, observational study of two screening strategies: annual PSA screening and no screening. We used data from 537,599 US Medicare (2001-2008) beneficiaries age 67-84 years who had a good life expectancy, no previous PC, and no PSA test in the 2 years before baseline. We estimated the 8-year PC mortality and incidence, treatments for PC, and treatment complications of PSA screening.In men age 67-74 years, the estimated difference in 8-year risk of PC death between PSA screening and no screening was -2.3 (95% CI, -4.1 to -1.1) deaths per 1,000 men (a negative risk difference favors screening). Treatment complications were more frequent under PSA screening than under no screening. In men age 75-84 years, risk difference estimates were closer to zero.Our estimates suggest that under conventional statistical criteria, annual PSA screening for 8 years is highly compatible with reductions of PC mortality from four to one fewer PC deaths per 1,000 screened men age 67-74 years. As with any study using real-world data, the estimates could be affected by residual confounding.