Screening Asymptomatic Men for Prostate Cancer Using Prostate-Specific Antigen as An Early Detection Tool: A Review of Existing Literature

Abstract

Prostate cancer remains the most common non-skin cancer in men. Prostate-specific antigen (PSA) is recognized as a biomarker for the diagnosis, monitoring, and risk prediction of prostate cancer. However, its role in prostate cancer screening has been controversial. While some authorities have recommended its use for screening, others have stated otherwise. Some clarity is required about its precise role in clinical practice. There need to be more consistent recommendations surrounding using PSA screening in clinical practice. Serum PSA measurements show variable reliability when screening for Prostate cancer, given the dynamics of PSA physiology and the conflicting results from two large, randomized control trials that sought to determine its role in prostate cancer screening and early detection. Hence surrogate measures like PSA density, PSA velocity, free-to-complexed PSA ratio, and percentage Pro-PSA among others, have been used to improve the predictive utility of this assay for Prostate cancer diagnosis. However, the debate on screening still lingers. The current review aims to highlight the controversies and objectively outline the current recommendations. This literature review examined scholarly papers and recommendations about the use of PSA for prostate cancer screening with the aim to rationalize the pros and cons of such approaches. We concluded that although more recent guidelines from the USPSTF recommend that screening be based on individual preference and professional judgment by the healthcare provider, differences in the specific details on how to best employ a PSA screening program still exist and require further review.