Prostate cancer screening: Is it time for a new approach? A review article

Abstract

Prostate cancer screening has presented a challenge to clinicians. Although the implementation of screening tests such as prostate-specific antigen (PSA) and digital rectal exam (DRE) has had a significant impact on prostate-cancer-specific mortality, these traditional screening tests have a relatively poor positive predictive value of clinically significant prostate cancer (CSPC), leading to unnecessary biopsies and treatment with a host of potential complications. Fortunately, much research regarding this topic has been done and is ongoing. This includes the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial, which underwent a secondary analysis to identify an association between PSA level and CSPC, and the IP1-PROSTAGRAM Trial, which evaluated the efficacy of multiparametric magnetic resonance imaging (mpMRI) in prostate cancer screening. Studies such as these have helped tremendously in establishing appropriate PSA cutoffs, the proper use of DRE, and the promise that MRI demonstrates with the goal of maximizing CSPC diagnoses while minimizing unnecessary biopsies or treatment.