Screening for prostate cancer: evidence, ongoing trials, policies and knowledge gaps

Abstract

Long-term screening with serum prostate-specific antigen (PSA) and systematic prostate biopsies can reduce prostate cancer mortality but leads to unacceptable overdiagnosis. Over the past decade, diagnostic methods have improved and the indolent nature of low-grade prostate cancer has been established. These advances now enable more selective detection of potentially lethal prostate cancer. This non-systematic review summarises relevant diagnostic advances, previous and ongoing screening trials, healthcare policies and important remaining knowledge gaps.Evidence synthesis and conclusions: The strong association between low serum PSA values and minimal long-term risk of prostate cancer death allows for adjusting screening intervals. Use of risk calculators, biomarkers and MRI to select men with a raised PSA value for biopsy and lesion-targeting rather than systematic prostate biopsies reduce the detection of low-grade cancer and thereby overdiagnosis. These improvements recently led the European Union to recommend its member states to evaluate the feasibility and effectiveness of organised screening programmes for prostate cancer. Nonetheless, important knowledge gaps remain such as the performance of modern diagnostic methods in long-term screening programmes and their impact on mortality. The knowledge gaps are currently being addressed in three large randomised screening trials. Population-based pilot programmes will contribute critical practical experience.

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“…A 12-year follow-up indicated a 50% reduction in metastatic disease at diagnosis and a 30% reduction overall. An analysis accounting for non-compliance and PSA testing in the control group demonstrated a net mortality reduction of 51% among screening participants (intention-to-screen analysis: 32%) [15,22,23].…”

Futuristic Silicon Photonic Biosensor with Nanomaterial Enhancement for PSA Detection

“…To ensure survival and good treatment outcomes, it is extremely important to detect prostate cancer early. Thus, early detection for prostate cancer is achieved by quantifying the levels of prostate specific antigen (PSA), the biomarker for prostate cancer, in the blood [20]. The normal level of PSA in human serum is less than 4 ng/mL.…”

Can PSA testing become appropriate public health policy?

“…Bratt et al recently published a detailed summary of the problems associated with traditional PSA screening and the current trials underway designed to improve PSA-based testing algorithms. 6 Moore et al wisely state that they need to evaluate their proposed screening strategy in a larger UK population. Over 20% of the invitees were referred for prostate biopsy.…”