ThePSA test– a measure of prostate-specific antigen levels in the blood – is used to screen for prostate problems, and is often the first test for men who are worried about prostate cancer. While elevated PSA levels could be an early warning sign of prostate cancer, a rise in PSA can also be caused byother factors包括尿感染，长时间运动和前列腺炎。
Routine screening to monitor prostate cancer risk is therefore highly controversial, and screening recommendations vary across countries. For example, theUS Preventive Services Task Forcerecommends against screening in all men, whereasmany guidelines提倡医生之间共享决策和patients.
In a论坛文章published today inBMC Medicineas part of ourSpotlight on prostate cancer文章收集，我们试图确定专家对PSA筛查下一步的看法。来宾编辑Sigrid Carlsson和Andrew Vickersquestioned some of the world’s key opinion leaders on exactly who should be screened for prostate cancer, and when this should be done.
Opinions from the screening proponents
。。。我认为，基于人群的筛查的时间尚未到来，也可能永远不会这样
Fritz Schröder
Michael Leapman和Peter Carroll通常被认为是前列腺癌筛查的支持者，他解释说，有令人信服的证据表明，PSA筛查与前列腺癌死亡减少有关。
Acknowledging the issue that routine PSA screening would lead to the detection of clinically insignificant prostate cancer – resulting in overtreatment in some men – Leapman and Carroll advocate that for asymptomatic men, patients and physicians should together discuss the pros and cons of screening, taking the patient’s preferences and risk factors into account.
Fritz Schröder解释说，通过PSA筛查诊断临床上微不足道的前列腺癌（不太可能在临床上进展或症状）的机会约为40％。总结说“我认为，基于人群的筛查的时间尚未到来，也可能永远不会这样”，Schröder还建议使用共同的决策方法来使用PSA筛选SIU决策援助。
The skeptics’ views
我相信应该放弃PSA测试吗？当然，筛查显然使某些男人受益
Peter Albertsen
Vickers and Carlsson also asked those who have been considered skeptical about prostate cancer screening about what they think current policy should be.Peter Albertsen概述了使用PSA作为筛查工具的一些问题，包括高阳性结果的高率以及缺失致死肿瘤的可能性。但是，艾伯森还提倡一种共同的决策方法，强调了：
“我相信应该放弃PSA测试吗？当然，筛查显然使某些男人受益”
艾伯森得出的结论是，他强烈支持美国泌尿外科协会指南，但是我们需要进一步完善应进行测试的男子，并制定最佳的实践筛查和治疗算法。
Dragan Ilicdiscussed the results of a recent荟萃分析of five trials examining the effectiveness of population-based screening, emphasizing that there was no significant difference in mortality between those men who underwent screening and those who did not.
Turning to focus on the benefits and harms of screening for the individual, Ilic shared the other authors’ recommendations that the decision about whether to undergo PSA testing should be shared between patients and physicians.
Ilic favored a discussion of the results of key screening trials during patient trials, recommending that decision aids should be used to ensure patients are fully informed of the risks and benefits associated with screening.
Shared decision-making is key!
共同的决策可以帮助避免用沐浴水扔掉婴儿和PSA测试
迈克尔·巴里& Dominick Frosch
迈克尔·巴里和Dominick Frosch, experts in implementing shared decision-making in primary care, explained that different men will see the balance of benefits and harms differently, and agreed that decision aids are very important in supporting a shared decision-making process in primary care.
巴里（Barry）和弗罗斯（Frosch）解释说，患者和医生之间共同决策的实施需要从家长式医学文化转变为日常分享决策。作者强调，这种转变已经在进行中，得出结论：
“当数以百万计的患者与临床医生进行癌症筛查的共同决策时，我们绝对可以设想未来，这是由于获得高质量决策支持的促进”
Taking all the experts’ views into account, Vickers and Carlsson concluded that there is agreement among the authors that PSA screening should not be given routinely to all men, and shared decision-making between patients and physicians is essential before the PSA test can be given.
The Guest Editors highlight conflicting opinions from the different experts on how exactly shared decision-making should take place, particularly regarding the use of decision aids and the discusison of complex trial results in primary care. Vickers and Carlsson conclude that:
“现在是时候结束无菌，进行辩论，并专注于确保当代PSA筛选实践遵循最佳证据”
BMC Medicine’sSpotlight on prostate cancer由Sigrid Carlsson和Andrew Vickers编辑的客人收集，仍在开放，供研究和治疗的所有领域进行研究。请将任何提交前查询发送到bmcmedicineeditorial@biomedcentral.com。
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2014 median turnover times: initial decision three days; decision after peer review 41 days
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