Prostate Cancer Screening Guidelines: To PSA or Not to PSA?

Abstract

Prostate cancer (PCa) screening with PSA (prostate-specific antigen) remains controversial. PSA is specific to the organ but not to cancer, and different benign conditions can influence the value, which may lead to false-positive results. Treatment with 5α-reductase inhibitors decreases the PSA value, and therefore, it is vital to have a baseline PSA before initiating therapy and to correct the value when screening for PCa. Shared-decision making is critical before subjecting a patient to PSA screening. Trends are moving towards a risk-adapted approach where different biomarkers and risk calculators play a role. This review will outline the controversy of PSA screening, the current guidelines of PSA screening, and discuss its future. Until the novel biomarkers have outperformed PSA as the first line of screening, it should not hinder screening for clinically significant PCa.