Prostate-Specific Antigen Screening and Active Surveillance for High-Risk Individuals

Abstract

Bergengren et al 1 and Nelson et al 2 report on 2 important and controversial topics in prostate cancer:(1) prostate-specific antigen (PSA) screening and (2) active surveillance for high-risk individuals (ie, men of African ancestry). These 2 topics highlight the complexity of current practices in both the early detection of prostate cancer and the management of localized disease.In their study, Bergengren and colleagues 1 demonstrate that the use of PSA testing and the resultant increase in diagnostic activity, from 1996 to 2016, corresponded with a 15% decrease in prostate cancer deaths-at the expense of both overdiagnosis and overtreatment-when compared with a simulated scenario in which the use of diagnostic activity was held constant at the rate of testing in 1996 (the early period of routine PSA screening). The study found that the actual number of low-risk and intermediate-risk cancers was 148% higher and that the rate of definitive treatment was more than 2-fold higher compared with the simulated scenario. The modeling strategy used in this study applies both diagnostic and treatment paradigms from nearly 3 decades ago in its simulation model. This strategy, unfortunately, overemphasized past practices and does not adequately account for the significant advances that have been made in the field to date. For