Prostate Cancer (PCa) is the most common cancer affecting men and the second leading cause of cancer death among American men (Qaseem, Denberg, Owens, & Shekelle, 2013). Medical professionals have been using prostate specific antigen (PSA) screenings along with digital rectal exam (DRE) for many years to screen for prostate cancer. PSA was first identified in 1966 in semen, followed by the identification of PSA in blood in 1979. The PSA test has been approved for use since 1994 to detect early prostate cancer. Most men that are greater than 50 years of age in the U.S. have had PSA screening, and many have been tested repeatedly. DRE is performed to determine prostate location, size, and the presence of nodules.
Despite widespread use of prostate specific antigen serologic testing and DRE to screen for PCa in men, authorities disagree on the benefit and optimal use of these screenings. The controversial issues are as follows. PSA screening leads to over detection of harmless or insignificant tumors and therefore over treatment. There is inconsistent evidence and at best a modest effect that PSA screening actually reduces the risk of death from PCa. Current practice of reassuring men who have a PSA level < 4 ng/ml that they are cancer free is no longer justified. Lastly, a decreasing correlation has been reported between PSA volume and the largest tumor in prostate gland. Furthermore, no controlled studies have shown a reduction in morbidity or mortality with use of DRE. DRE is also limited to peripheral tumors, and some are non palpable. This emphasizes the need for changing the approach of screening and treating PCa.
In 2002 USPSTF gave PSA screening grade of I; concluding there was insufficient evidence to recomme...
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Howrey, B. T., Kuo, Y., Lin, Y., & Goodwin, J. S. (2013). The Impact of PSA Screening on PCaMortality and Overdiagnosis of PCain the United States. Journals Of Gerontology: Series A: Biological Sciences And Medical Sciences, 68(1), 56-61.
Nichol, M. B., Wu, J., Huang, J., Denham, D., Frencher, S. K., & Jacobsen, S. J. (2012). Cost-effectiveness of Prostate Health Index for PCa detection. BJU International, 110(3), 353-362. doi:10.1111/j.1464-410X.2011.10751.x
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