The incidence of prostate cancer in China is gradually increasing, and the proportion of newly diagnosed patients with advanced stages is higher in most regions than in European and American countries, which will have a direct impact on the treatment outcome and long-term survival of prostate cancer patients in China. In order to promote the scientific and standardized early diagnosis of prostate cancer in urology, the members of this study have developed this “Expert Consensus on Early Diagnosis of Prostate Cancer in China” based on the “Chinese Guidelines for Diagnosis and Treatment of Urological Diseases”, the current situation of early diagnosis of prostate cancer in China, and the latest literature reports with reference to the relevant contents of foreign guidelines. The first “Expert Consensus on Early Diagnosis of Prostate Cancer in China” is based on the current situation of early diagnosis of prostate cancer in China, referring to overseas guidelines and latest literature. The incidence of prostate cancer has significant geographical and racial differences. In this article, the term “early diagnosis of prostate cancer” refers to “diagnosis of clinically limited prostate cancer”. The incidence of prostate cancer is the second most common malignancy in men worldwide. The incidence of prostate cancer in China is relatively low, but in recent years there has been a significant increase in the trend. Since 2008, prostate cancer has become the malignant tumor with the highest incidence in the urinary system, with the incidence rate reaching 9.92/100,000 in 2009. The incidence rate of prostate cancer in China varies greatly between urban and rural areas, especially the incidence rate in large cities is higher. At present, the accepted clinical diagnosis model of prostate cancer is the “three-step” method: ①Detection of suspicious cases by tumor markers such as PSA and digital rectalexamination (DRE). (ii) Depending on the specific situation, the localization of the suspected lesion is completed by imaging examinations such as transrectal uItrasongraphy (TRUS) and multiparametric magnetic resonance imaging (MRI). The pathological diagnosis is obtained by TRUS-guided prostate system biopsy. Key points of the guidelines: I. PSA examination 1. PSA screening: PSA-based prostate cancer screening specifically refers to PSA examination in a specific population of healthy men without symptoms, with the aim of early detection of prostate cancer and ultimately reducing its morbidity and mortality. 2. Clinical PSA examination and result determination: PSA examination is different from PSA screening, which often occurs in urology clinics and annual health checkups in China. The following points should be noted for clinical PSA examination: (1) PSA examination indications: ①Men over 50 years old with lower urinary tract symptoms need to undergo PSA examination; ②Men with a family history of prostate cancer, coincidental A examination should be advanced to 45 years old; ③Men with abnormal DRE or prostate imaging should also undergo PSA examination. (2) Frequency of testing: ① those aged 45-49 years with normal DRE and PSA >1μg/L, PSA should be rechecked in 1-2 years; ② those with normal DRE and PSA ≤μg/L should be rechecked at the age of 50 years; ③ those over 50 years old with normal DRE and PSA <3μg/L and no other indications for puncture, PSA should be rechecked in 1-2 years. (3) Influencing factors: factors affecting serum PSA level Including mechanical extrusion of the prostate (such as DRE, urinary retention, cystoscopy, etc.) as well as urinary tract infections, hematuria and other factors, so the test should be performed 24h after ejaculation, 48h after cystoscopy, catheterization and other operations, 1 week after DRE, and 1 month after prostate puncture. It is recommended that routine urinalysis be performed at the same time as PSA testing to exclude the effects of hematuria and/or inflammation. (4) Normal PSA value: A serum total PSA (tPSA) >4.0 μg/L is considered abnormal and is recommended to be rechecked in a few weeks for initial PSA abnormalities. Serum PSA is affected by factors such as age and prostate size. Some data show that PSA levels in men of different ages in China are ≤2.15μg/L for 40~49 years old, ≤3.20μg/L for 50~59 years old, ≤4.10μg/L for 60~69 years old and ≤5.37μg/L for 70~79 years old, all lower than men in western countries. II. It is simple and easy to perform, painless for the examined patient, and is an important test for the early diagnosis of prostate cancer. Members of the writing group suggested that urologists must be proficient in DRE operation skills. Most prostate cancers originate in the peripheral zone of the prostate and are easily detected by DRE when the tumor volume exceeds 0.2 ml. About 18% of prostate cancer patients are detected by DRE alone, and patients with abnormal DRE tend to have a higher score of prostate cancer. The typical peripheral zone hypoechoic nodal sign of prostate cancer is not common in TRUS examination, especially for early stage prostate cancer patients, TRUS examination has limited value and low diagnostic specificity. In addition, TRUS-guided point-of-interest puncture alone does not replace systemic puncture. 2.MRI:The value of MRI in the diagnosis of prostate cancer has gained more and more widespread recognition in recent years, especially the multiparametric MRI technique combining sequences of wave spectrum analysis and dynamic diffusion weighting, which is of greater value for the early diagnosis and clinical staging of prostate cancer. Since early prostate cancer lesions are small in size, multifocal and scattered in growth, therefore, for patients with negative initial puncture, targeted prostate puncture biopsy can be performed by TRUS and multiparametric MRI image fusion technique, which can improve the detection rate of early prostate cancer by about 20% as reported in foreign literature. The clinical value of CT and whole-body nuclide bone scan in the early diagnosis of prostate cancer is limited, and it only has an auxiliary role in determining lymph node and bone metastasis. Prostate puncture biopsy is the most reliable means to confirm the diagnosis of prostate cancer, and an accurate and effective prostate puncture biopsy is important for the diagnosis of early prostate cancer. The results of a survey on the status of prostate puncture biopsy conducted by the China Prostate Cancer Consortium (CPCC) showed that patients with prostate puncture biopsy in China are older, have higher PSA, smaller prostate volume, higher Gleason score and lower positive rate compared to those in Europe and the United States. This may be related to the different puncture strategies adopted in different regions. The indications for prostate puncture biopsy recommended by this consensus include: (i) prostate nodules found by DRE, any PSA value; (ii) abnormal findings by MRI and TRUS, any PSA value; (iii) PSA >10 μg/L; (iv) PSA 4~10 μg/L, abnormal f/t PSA or abnormal PSAD value.