Controversies and Opportunities for PSA Screening
The use of serum prostate specific antigen (PSA) to screen for prostate cancer remains one of the major controversies in modern medicine, despite its wide use in the general population. PSA-screening is controversial because: (1) results of recent clinical trials provide conflicting answers to the question of whether population-based PSA screening decreases prostate cancer-related mortality. (2) There is no agreed upon PSA threshold at which to perform a biopsy. (3) The current use of PSA results in the overdiagnosis of harmless cancers. While PSA does have well-recognized limitations, recent research demonstrates that serum PSA can be used to reduce unneeded biopsies and minimize the detection of indolent cancers. We review current opportunities in prostate cancer screening including: PSA-based risk calculators, improvement in the diagnostic accuracy of PSA with 5-alpha reductase inhibitors, the use of PSA to predict long-term cancer risk, and novel biomarkers that are currently available or in clinical trials. With these tools, the risks associated with PSA-based screening including unneeded biopsy, overdiagnosis and overtreatment are likely to subside.
KeywordsProstate Cancer Prostate Specific Antigen Prostate Biopsy Prostate Cancer Risk Prostate Cancer Screening
- 19.http://deb.uthscsa.edu/URORiskCalc/Pages/uroriskcalc.jsp. Accessed 10/2011.
- 22.http://sunnybrook.ca/content/?page=OCC_prostateCalc. Accessed 10/2011.
- 23.http://www.prostatecancer-riskcalculator.com/via.html. Accessed 10/2011.
- 25.Andriole GL, Bostwick D, Brawley OW, et al. REDUCE Study Group: the effect of dutasteride on the usefulness of prostate specific antigen for the diagnosis of high grade and clinically relevant prostate cancer in men with a previous negative biopsy: results from the REDUCE study. J Urol. 2011;185(1):126–31.PubMedCrossRefGoogle Scholar
- 26.Roehrborn CG, Andriole GL, Wilson TH, Castro R, Rittmaster RS. Effect of dutasteride on prostate biopsy rates and the diagnosis of prostate cancer in men with lower urinary tract symptoms and enlarged prostates in the Combination of Avodart and Tamsulosin trial. Eur Urol. 2011;59(2):244–9.PubMedCrossRefGoogle Scholar
- 37.Sokoll LJ, Sanda MG, Feng Z, et al. A prospective, multicenter, National Cancer Institute Early Detection Research Network study of [−2]proPSA: improving prostate cancer detection and correlating with cancer aggressiveness. Cancer Epidemiol Biomarkers Prev. 2010;19(5):1193–200.PubMedCrossRefGoogle Scholar