Prostate cancer is the second leading cause of cancer death amongst men in the United States. One in six men is estimated to be diagnosed with prostate cancer at some point in their lives. Similar trends are found worldwide to mirror those of the United States.1 However, the progression of prostate cancer is typically slow and does not metastasize all that often.2 Due to this, treatments can typically be life saving and prostate cancer deaths have declined ~35% from 1997 to 2007. This can partially be explained by lifestyle changes, hormone therapy, radiation therapy, chemotherapy, and surgical treatment; however, large scale screening using prostate specific antigen (PSA) has to account for a substantial impact on the incidence and mortality rates for prostate cancer.3
Prior to the 1980’s the digital rectal exam (DRE) was the primary method, physicians used to detect prostate cancer. Today, along with the DRE, PSA is the most common way physicians diagnose prostate cancer. However, PSA is not 100% accurate in diagnosing prostate cancer. It can be falsely elevated by certain conditions, both benign and malignant types of prostate cancer will elevate the PSA, and some men with prostate cancer will not have an elevated PSA. Even with these negatives the PSA has become the major serum marker for prostate cancer screening. Once an abnormal PSA comes back it is indicated for them to receive a prostate biopsy.4 So we will review the current guidelines for PSA screening and the current evidence both for and against it.
While PSA has reduced the mortality rate of prostate cancer, it has also increased the over diagnosis and over treatment of indolent cancers; which lead to treatment...
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...rior to the two larger trials showing better outcomes for those patients screened with PSA. The main reasons for showing benefit over the other larger trials are due to the longer screening time of 18 years, less contamination amongst the control group, and shorter screening times of 2 years compared to 4 years.3
In conclusion, there is a place for PSA screening for prostate cancer, which clearly shows a benefit in decreased mortality amongst those who are screened compared to those who are not screened. The two downsides, which can’t be ignored, are the association of over-diagnosis and over-treatment of the indolent and less aggressive cancers. As long as the provider has an open dialog with the patient so they can make an informed decision on their health and the risks and benefits that go along with it, PSA screening should continue to be offered to population.
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