台灣南部社區型攝護腺特異抗原篩檢計畫之初步成果

劉佳旻^1,2,3、王彰德⁴、沈志宇^1,3、陳俊孚¹、謝嘉興¹、蕭筠儒⁵、陳姿君⁵、歐建慧^1,2    

1衛生福利部台南醫院泌尿科; 2成功大學附設醫學院附設醫院泌尿部; 3成功大學醫學院臨床醫學研究所; 4衛生福利部台南醫院新化分院泌尿科; 5衛生福利部台南醫院

Preliminary Results of a Community-Based PSA Screening Program in Southern Taiwan

Chia-Min Liu^{1, 2,3}, Chang-Te Wang⁴, Chih-Yu Shen^{1, 3}, Chun-Fu Chen¹, Chia-Hsing Hsieh¹, Yun-Ru Hsiao⁵, Tzu-Chun Chen⁵, Chien-Hui Ou^{1, 2}     

1        Department of Urology, Tainan Hospital Ministry of Health and Welfare; 2 Department of Urology, National Cheng Kung University Hospital; 3 Institute of Clinical Medicine, College of Medicine, National Cheng Kung University; 4 Department of Urology, Xinhua Branch, Tainan Hospital Ministry of Health and Welfare; 5 Tainan Hospital Ministry of Health and Welfare

Purpose:

To report the preliminary results of a community-based prostate-specific antigen (PSA) screening program and evaluate the rates of PSA elevation, abnormal lower urinary tract symptom scores, prostate biopsy, and prostate cancer detection in men aged over 50 years in Southern Taiwan.

Materials and Methods:

Men aged over 50 years, regardless of the presence of lower urinary tract symptoms, were eligible if they had not been under regular follow-up in a urology clinic and had not undergone PSA testing within the preceding year. From October 1, 2025 to February 28, 2026, a total of 3,497 men underwent PSA testing and filled in the questionnaire of International Prostate Symptom Score (IPSS). Elevated PSA was defined as a serum PSA level >4 ng/ml, and abnormal IPSS was defined as IPSS ≥8. Among men with elevated PSA, PSA levels were further categorized as 4-10ng/ml, 10-20 ng/ml and >20 ng/ml. Prostate biopsy, including transrectal ultrasound(TRUS) guided biopsy and magnetic resonance imaging(MRI)-ultrasound fusion biopsy were performed according to clinical judgement and shared decision making after fully explained to patients. Clinically significant prostate cancer was defined as biopsy proven prostate cancer with International Society of Urological Pathology (ISUP) grade group ≥ 2 and PSA ≥10.

Results:

Among 3497 screened men, 365 (10.58%) had elevated PSA levels and 801 (23.22%) had abnormal IPSS. Among men with elevated PSA, 300 had PSA levels of 4-10ng/ml, 35 had PSA levels of 10-20 ng/ml and 30 had PSA levels >20 ng/ml. A total of 94 prostate biopsies were performed, including 79 TRUS-guided biopsied and 14 MRI-ultrasound fusion biopsies. Prostate cancer were detected in 35 men (positive rates 37.2%), including 27 identified by TRUS-guided biopsy (positive rates 34.2%) and 8 by fusion biopsy(positive rates 53.3%). The overall prostate cancer detection rate was 1.0%. Clinically significant prostate cancer was identified in 28 men, accounting for 80% of all detected prostate cancer and 0.8% of the screened population. In age-stratified analysis, both PSA elevation and abnormal IPSS became more prevalent with increasing age.

Conclusion:

These preliminary results demonstrate that a community-based PSA screening program and identify a substantial proportion of men with elevated PSA, abnormal urinary symptom burden and previously undiagnosed prostate cancer, most of which were clinically significant. Continued follow-up and further analysis are warranted to better define the clinical utility and cancer detection performance, even the benefit for overall survival of this screening program in Southern Taiwan.