Prostate Cancer Screening and the Associated Controversy

https://doi.org/10.1016/j.suc.2015.05.001Get rights and content

Section snippets

Key points

  • Prostate-specific antigen (PSA) screening has reduced prostate cancer mortality but has also led to overdiagnosis and overtreatment.

  • In May 2012 the US Preventive Services Task Force (USPSTF) recommended against prostate cancer screening.

  • 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.

  • Active surveillance is a feasible strategy to reduce the harms of

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.

First page preview

First page preview
Click to open first page preview

References (76)

  • J. Hugosson et al.

    Mortality results from the Goteborg randomised population-based prostate-cancer screening trial

    Lancet Oncol

    (2010)
  • A. Aslani et al.

    The impact of recent screening recommendations on prostate cancer screening in a large health care system

    J Urol

    (2014)
  • J.A. Cohn et al.

    Primary care physician PSA screening practices before and after the final U.S. Preventive Services Task Force recommendation

    Urol Oncol

    (2014)
  • B. Bhindi et al.

    Impact of the U.S. Preventive Services Task Force Recommendations Against PSA Screening on Prostate Biopsy and Cancer Detection Rates

    J Urol

    (2015)
  • T.Y. Perez et al.

    Impact of the 2012 United States Preventive Services Task Force statement on prostate-specific antigen screening: analysis of urologic and primary care practices

    Urology

    (2015)
  • M.J. Maurice et al.

    Patient opinions on prostate cancer screening are swayed by the United States Preventative Services Task Force recommendations

    Urology

    (2014)
  • C.J. Kane et al.

    Outcomes after radical prostatectomy among men who are candidates for active surveillance: results from the SEARCH database

    Urology

    (2010)
  • K.L. Greene et al.

    Prostate specific antigen best practice statement: 2009 update

    J Urol

    (2009)
  • H.B. Carter et al.

    Early detection of prostate cancer: AUA Guideline

    J Urol

    (2013)
  • S. Carlsson et al.

    Predictive value of four kallikrein markers for pathologically insignificant compared with aggressive prostate cancer in radical prostatectomy specimens: results from the European Randomized Study of Screening for Prostate Cancer section Rotterdam

    Eur Urol

    (2013)
  • R. Siegel et al.

    Cancer statistics, 2014

    CA Cancer J Clin

    (2014)
  • J.E. Johansson et al.

    High 10-year survival rate in patients with early, untreated prostatic cancer

    JAMA

    (1992)
  • J.E. Johansson et al.

    Fifteen-year survival in prostate cancer. A prospective, population-based study in Sweden

    JAMA

    (1997)
  • J.E. Johansson et al.

    Natural history of early, localized prostate cancer

    JAMA

    (2004)
  • P.C. Albertsen et al.

    Competing risk analysis of men aged 55 to 74 years at diagnosis managed conservatively for clinically localized prostate cancer

    JAMA

    (1998)
  • P.C. Albertsen et al.

    20-year outcomes following conservative management of clinically localized prostate cancer

    JAMA

    (2005)
  • O.W. Brawley

    Prostate cancer epidemiology in the United States

    World J Urol

    (2012)
  • H. Lilja et al.

    Prostate-specific antigen and prostate cancer: prediction, detection and monitoring

    Nat Rev Cancer

    (2008)
  • M.C. Wang et al.

    Purification of a human prostate specific antigen

    Invest Urol

    (1979)
  • M. Kuriyama et al.

    Quantitation of prostate-specific antigen in serum by a sensitive enzyme immunoassay

    Cancer Res

    (1980)
  • T.A. Stamey et al.

    Prostate-specific antigen as a serum marker for adenocarcinoma of the prostate

    N Engl J Med

    (1987)
  • W.J. Catalona et al.

    Measurement of prostate-specific antigen in serum as a screening test for prostate cancer

    N Engl J Med

    (1991)
  • National Cancer Institute, Surveillance, Epidemiology, and End Results Program. 2015. Available at:...
  • R.E. Tarone et al.

    Implications of stage-specific survival rates in assessing recent declines in prostate cancer mortality rates

    Epidemiology

    (2000)
  • R. Etzioni et al.

    Cancer surveillance series: interpreting trends in prostate cancer–part III: Quantifying the link between population prostate-specific antigen testing and recent declines in prostate cancer mortality

    J Natl Cancer Inst

    (1999)
  • P.C. Walsh

    Cancer surveillance series: interpreting trends in prostate cancer–part I: evidence of the effects of screening in recent prostate cancer incidence, mortality, and survival rates

    J Urol

    (2000)
  • E.J. Feuer et al.

    Cancer surveillance series: interpreting trends in prostate cancer–part II: cause of death misclassification and the recent rise and fall in prostate cancer mortality

    J Natl Cancer Inst

    (1999)
  • R. Etzioni et al.

    The prostate cancer conundrum revisited: treatment changes and prostate cancer mortality declines

    Cancer

    (2012)
  • Cited by (0)

    View full text