编者按：在2025年欧洲泌尿外科协会（EAU）大会上，来自荷兰鹿特丹伊拉斯姆医学中心（Erasmus MC）的Renée C.A. Leenen教授汇报了欧洲前列腺癌筛查随机研究（ERSPC）20年随访的最新结果。在这项研究中，她的团队专注于一个特定亚组——筛查未参与者，即那些被邀请接受基于PSA筛查但选择不参加的男性。该二次分析结果为这一人群的前列腺癌特异性死亡率提供了新的见解，并引发了关于筛查项目的设计和实施方式的重要问题——尤其是针对高危人群。

01

《肿瘤瞭望-泌尿时讯》：您在EAU大会上分享了前列腺癌筛查研究的长期随访数据。您能否分享一下主要发现？这项研究对临床实践带来了哪些启示？

Dr. Renée C.A. Leenen：在这次会议上，我展示了我们在ERSPC中进行的一项二次分析的20年随访结果。这是一项评估基于PSA筛查对前列腺癌特异性死亡率影响的随机、基于人群的试验。该研究始于20世纪90年代初，因此我们现在拥有了非常成熟的资料。

在这次分析中，我们特别关注了那些被邀请接受PSA筛查但没有参加的男性。我们发现，与对照组中从未接受过筛查的男性相比，这些未参与者死于前列腺癌的风险要高得多。这是一个引人注目的结果。它告诉我们，尽管提供了筛查机会，但未参与者仍然处于特别高的风险之中。我们相信这可能是由于他们在预防性医疗保健方面的参与度较低，这可能受到社会经济地位等因素的影响。从临床角度来看，这突显了我们需要更好地了解这些男性是谁以及如何接触他们。我们知道，癌症筛查的参与率通常较低且呈下降趋势，而这项研究表明，不参与的后果是非常严重的。我们需要更好的策略来促进知情参与，并使筛查更加便捷和公平。

UroStream: You shared the long-term follow-up data of the prostate cancer screening study at the EAU conference. Could you please share the main findings? What implications does this study bring to clinical practice?

Dr. Renée C.A. Leenen: Thank you for interviewing me. My name is Renée Leenen. I’m a medical doctor working at Erasmus MC in Rotterdam, the Netherlands.I presented the 20-year follow-up outcomes of a secondary analysis we conducted within the ERSPC. This is a randomized, population-based trial that evaluates the effect of PSA-based screening on prostate cancer–specific mortality. The study began in the early 1990s, so we now have very mature data.

In this analysis, we specifically looked at men who were invited to undergo PSA screening but did not attend. We found that these non-attenders had a much higher risk of dying from prostate cancer compared to men in the control group, who were never offered screening at all. That’s a striking result. It tells us that non-attenders—despite being offered access to screening—are at particularly high risk. We believe this may be due to lower engagement in preventive healthcare, possibly influenced by factors like socioeconomic status.From a clinical perspective, this highlights the need to better understand who these men are and how to reach them. We know that participation rates in cancer screening are generally low and declining, and this study shows that the consequences of non-participation are very serious. We need better strategies to promote informed participation and make screening more accessible and equitable.

02

《肿瘤瞭望-泌尿时讯》：研究表明，筛查组中有17%的男性从未参与筛查。您认为可能导致这一群体前列腺癌筛查参与率低的因素有哪些？

Dr. Renée C.A. Leenen：这是一个需要解决的重要问题。世界卫生组织建议筛查项目的参与率至少为70%，才能有效。但实际上，即使是欧洲的结直肠癌筛查项目也难以达到这一目标——只有一个成员国超过了这一比例。在当代的前列腺癌筛查试验中，参与率甚至更低。至于原因，有几种可能性。有些人认为，对政府或医疗机构的信任度下降可能是一个因素。另一些人则认为，人们可能只是不太清楚筛查的存在，或者他们应该参与其中。例如，乳腺癌筛查在历史上曾有很高的参与率，但如今也呈下降趋势。因此，这一问题可能并不局限于前列腺癌——它可能反映了公众参与预防性健康的一个更广泛趋势。

UroStream: Studies have shown that 17% of men in the screening group never participated in screening. What factors do you think may lead to the low participation rate in prostate cancer screening among this group of people?

Dr. Renée C.A. Leenen: Yes, and that’s important to address. The World Health Organization recommends a minimum 70% participation rate for screening programs to be effective. But in reality, even colorectal cancer screening programs in Europe have struggled to meet that target—only one member state has exceeded it. In contemporary prostate cancer screening trials, the rates are even lower.As for the reasons, there are a few possibilities. Some people suggest that declining trust in government or healthcare institutions could be playing a role. Others think that people may simply be less aware that screening is available, or that they should take part.For example, even breast cancer screening, which historically had high participation rates, is seeing a decline. So the issue may not be limited to prostate cancer —it may reflect a broader trend in public engagement with preventive health.

03

《肿瘤瞭望-泌尿时讯》：早期筛查和早期诊断可以改善前列腺癌患者，特别是高危患者的情况。根据您的临床经验，您认为我们如何能够提高高危人群的筛查依从性？

Dr. Renée C.A. Leenen：这真的要从提高意识开始。那些风险最高的男性需要被告知筛查的存在，它与他们息息相关，而且早期发现可以显著改善他们的预后。这不仅仅是发送邀请的问题——而是要确保他们明白为什么这很重要，并且他们在采取这一步骤时能得到支持。

UroStream: Early screening and early diagnosis can improve the prostate cancer patients, especially the high-risk patients. Based on clinical experience, how do you think we can improve the screening compliance of the high-risk population?

Dr. Renée C.A. Leenen: It really starts with awareness. The men who are most at risk need to be informed that screening exists, that it's relevant to them, and that early detection could significantly improve their outcomes. It’s not just about sending an invitation—it’s about making sure they understand why it matters, and that they feel supported in taking that step.

04

《肿瘤瞭望-泌尿时讯》：前列腺癌筛查的选择随着每一天都在变化。您如何看待新的生物标志物在前列腺癌筛查中的应用？

Dr. Renée C.A. Leenen：这是一个非常令人兴奋的领域。目前正在进行大量的研究，许多新的生物标志物正在被讨论和开发。ERSPC仅基于PSA筛查，PSA水平高会直接导致进行活检。我们已经看到，这可以降低前列腺癌特异性死亡率，但我们同时也了解到，一刀切的方法并不理想。这就是为什么风险分层如此重要——而生物标志物可以在其中发挥关键作用。它们使我们能够完善筛查过程，减少不必要的活检，并更好地识别那些真正需要进一步检查的男性。

UroStream: Prostate cancer screening options are changing with each passing day. What do you think about the application of new biomarkers in prostate cancer screening?

Dr. Renée C.A. Leenen: It’s a very exciting area. There’s a lot of ongoing research and many new biomarkers are being discussed and developed. The ERSPC was based solely on PSA screening, where a high PSA level led directly to biopsy. We’ve seen that this reduces prostate cancer–specific mortality, but we also learned that a one-size-fits-all approach is not ideal. That’s why risk stratification is so important—and biomarkers can play a key role in that. They allow us to refine the screening process, reduce unnecessary biopsies, and better identify the men who truly need further investigation.