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Prostate-specific antigen (PSA) screening has reduced prostate cancer mortality but has also led to overdiagnosis and overtreatment.
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In May 2012 the US Preventive Services Task Force (USPSTF) recommended against prostate cancer screening.
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In response to the USPSTF, professional organizations issued updated guidelines advocating for shared decision making between patients and physicians regarding the risks and benefits of screening.
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Active surveillance is a feasible strategy to reduce the harms of
Prostate Cancer Screening and the Associated Controversy
Section snippets
Key points
Prostate-Specific Antigen
PSA is a serine protease released into the seminal fluid that lyses the seminal fluid protein seminogelin during the process of semen liquefaction.2, 13 Production of PSA is restricted to the prostatic epithelium and transcription of PSA is driven by androgens.13 PSA levels in the blood are typically low, but can be increased owing to disruption of normal prostatic architecture, which occurs with malignant processes such as cancer or benign processes that include benign prostatic hyperplasia,
Prostate Cancer Screening Trials: Prostate, Lung, Colorectal, and Ovarian and European Randomized Study of Screening for Prostate Cancer
Two large, randomized trials assessing the effect of PSA screening on prostate cancer were recently published. The first trial was the Prostate, Lung, Colorectal, and Ovarian (PLCO) cancer screening trial conducted at 10 centers in the United States.34 The study reported on 76,693 men ages 55 to 74 years old who were randomized to either annual screening or usual care. Men in the screening group were offered annual PSA and DRE, whereas the usual care group served as the control group and
Critique of the US Preventive Services Task Force Recommendation
The USPSTF recommendation against prostate cancer screening was met with criticism from several professional organizations including the American Urologic Association (AUA) and the Society of Urologic Oncology owing to concerns that the recommendation was a disservice to men that could cause more harm than intended.41, 42 Furthermore, analysis of the USPSTF recommendation statement40 and the USPSTF’s evidence review43 upon which their recommendations were formulated demonstrates that the USPSTF
Summary
PSA screening has decreased prostate cancer mortality; however, there is concern that PSA screening has led to overdiagnosis and overtreatment of clinically insignificant prostate cancers. The USPSTF recently released a controversial statement recommending against the use of PSA for prostate cancer screening. Prostate cancer is the most common malignancy diagnosed in men and is the second leading cause of cancer death for men in the United States, accounting for 30,000 deaths per year.
References (76)
- et al.
Use and assessment of PSA in prostate cancer
Med Clin North Am
(2011) - et al.
The frequency of carcinoma and intraepithelial neoplasia of the prostate in young male patients
J Urol
(1993) - et al.
Natural history of localised prostatic cancer. A population-based study in 223 untreated patients
Lancet
(1989) - et al.
Natural history of early, localized prostate cancer: a final report from three decades of follow-up
Eur Urol
(2013) Hereditary prostate cancer: clinical aspects
J Urol
(2002)- et al.
Screening for prostatic carcinoma with prostate specific antigen
J Urol
(1992) - et al.
Trends in mortality rates in patients with prostate cancer during the era of prostate specific antigen screening
J Urol
(2000) - et al.
Pathologic stage migration has slowed in the late PSA era
Urology
(2007) - et al.
Screening and prostate cancer mortality: results of the European Randomised Study of Screening for Prostate Cancer (ERSPC) at 13 years of follow-up
Lancet
(2014) - et al.
What do the screening trials really tell us and where do we go from here?
Urol Clin North Am
(2014)