攝護腺特異抗原PSA應該多久檢查一次

2025-02-11 今天遇到排尿不順的中年男性想來驗 PSA

Sensitivity and specificity of prostate-specific antigen for prostate cancer detection with high rates of biopsy verification

攝護腺癌. 如果以 4 ng/mL 做為閾值. 僅能抓到 20% 的個案. 會遺失掉 80% 病患. 

How sensitive is PSA for prostate cancer?

For prostate cancer, the standard PSA cut-off of 4 ng/mL has low sensitivity: with this cut-off only 20.5% of the prostate cancer cases test positive-nearly 80% of prostate cancer cases are missed.

但PSA異常的人. 有九成以上的機率不是攝護腺癌. 

Prostate-Specific Antigen

Overall, PSA sensitivity ranges from 9% to 33%, depending on age and the PSA cut-off values, indicating that up to 91% of individuals with elevated serum PSA levels do not have prostate cancer.[17] In clinical practice, the actual risk of prostate cancer in men with an elevated PSA is roughly 30%. Most malignancies found due to elevated PSA levels are low-risk prostate cancers that are often managed by monitoring with active surveillance. Only about 25% of men managed by active surveillance experience a progression of their cancer that requires definitive therapy.

2019-12-18 
攝護腺特異抗原PSA篩檢. 75歲以上不建議做 PSA篩檢

50歲以上無症狀. 可考慮篩檢 一等親罹患攝護腺癌. 45歲以上可考慮篩檢 家族多人罹患攝護腺癌, 40歲以上可考慮. 歐盟泌尿協會不建議做為常規健檢項目 https://www.hpa.gov.tw/Pages/Detail.aspx?nodeid=1103&pid=6465 五、國際間PSA篩檢之建議

依據USPSTF在2008年之建議，雖然PSA檢查可以偵測早期的攝護腺癌，但針對75歲以下男性，現有證據尚不足以確定對其提供攝護腺癌篩檢是否利大於弊，且對於75歲以上的男性反對提供篩檢[5]。美國癌症學會(ACS)於2010年3月更新修正其原有指引，建議預期壽命尚有10年以上之無症狀男性，從50歲開始，應有機會被告知有關PSA篩檢之風險、潛在好處及不確定性，讓民眾在瞭解後自行選擇；另，高危險群，例如有一等親罹患攝護腺癌者，建議從45歲開始討論要不要做，若家族中有多人罹患攝護腺癌，則建議從40歲開始討論[6]。加拿大(2002)、澳大利亞(2008)、日本(2009)、英國NHS(2010)均指出沒有充分證據證實攝護腺癌篩檢可有效降低死亡率或不影響生活品質前，歐盟泌尿協會EAU(2009)則不建議將其列入國家健康照護政策[7]。 https://www.hpa.gov.tw/Pages/List.aspx?nodeid=1102