Prostate-specific antigen: does the current evidence support its use in prostate cancer screening?

Abstract

Although widely used, the value of prostate-specific antigen (PSA) in screening asymptomatic men for prostate cancer is controversial. Reasons for the controversy relate to PSA being less than an ideal marker in detecting early prostate cancer, the possibility that screening for prostate cancer may result in the overdetection and thus overtreatment of indolent disease and the lack of clarity as to the definitive or best treatment for men diagnosed with localized prostate cancer. Although the results from some randomized prospective trials suggest that screening with PSA reduces mortality from prostate cancer, the overall benefit was modest. It is thus currently unclear as to whether the modest benefit of reduced mortality outweighs the harms of overdetection and overtreatment. Thus, prior to undergoing screening for prostate cancer, men should be informed of the risks and benefits of early detection. Newly emerging markers that may complement PSA in the early detection of prostate cancer include specific isoforms of PSA and PCA3.

Prostate Cancer Awareness and Screening among Men in Eldoret, Kenya

“…Men who mentioned prostate cancer as one of the cancers they knew and those who knew that cancer affects men only were more likely to be screened. It has been shown that increased knowledge directly leads to increased uptake of screening [19], [20], [21]. Our study supports the need for increased education on prostate cancer understanding in order to increase screening.…”

Total, free, and complexed prostate-specific antigen levels among US men, 2007–2010

“…The screening for prostate cancer using the total prostate-specific antigen is common but remains controversial [2][3][4]. PSA tests are used to monitor patients with prostate cancer along with other diagnostic modalities.…”

“…The common screening tests for prostate cancer are digital rectal examination and the biomarker serum total PSA. Prostate cancer screening is common but has been controversial for many years [2][3][4]. Hayes and Barry recently reviewed randomized trials and modeling studies of screening for prostate cancer with the PSA test and found that two major trials have examined the role of PSA in screening for prostate cancer [5].…”

Deregulated expression of selected histone methylases and demethylases in prostate carcinoma

“…At its earliest stages, PCa is frequently asymptomatic, fostering the use of biomarkers, such as serum prostate-specific antigen (PSA), for screening and identification of asymptomatic low-stage tumors, followed by prostate biopsy for diagnosis confirmation (Stamey 1995). However, prostate biopsy meets with several limitations, including sampling error as well as intra-and interobserver variability in Gleason grading (King & Long 2000, Allsbrook et al 2001, which even in conjunction with other prognostic factors used for therapeutic decision (e.g., clinical stage and pre-therapeutic serum PSA levels) are rather imperfect in predicting disease progression (Lapointe et al 2004, Duffy 2011. Consequently, there is a significant degree of uncertainty concerning the threat that a PCa poses to an individual patient, entailing overtreatment (Moyer 2012).…”