The Evolving Paradigm of Prostate Cancer Screening

Abstract

The 1987 report by Stamey et al 1 showing that prostate-specific antigen (PSA) levels correlate with prostate cancer volume ushered in the modern age of prostate cancer management. Four years later, Catalona et al 2 published results from a large case series analysis showing that men undergoing biopsy as the result of an elevated serum PSA level frequently harbor prostate cancer. Shortly thereafter, screening for prostate cancer with serum PSA level became the standard of care in North America, and the incidence of prostate cancer tripled. 3 Equally important, clinicians during this era considered all cancers identified by PSA testing to be clinically significant; as a consequence, most of the men who received a diagnosis of prostate cancer underwent treatment with surgery or radiation. Unfortunately, many of these men experienced incontinence, impotence, or bowel dysfunction as a result. Many European countries, especially the United Kingdom, were much more hesitant to adopt PSA screening. Urologists in Scandinavian countries recognized that men with well-differentiated prostate cancer often lived many years with their disease without symptoms. They organized the

Current prostate cancer screening and treatment strategies may not support a holistic nationwide program

“…10 The correlation between elevated serum PSA levels and the possibility of finding a tumor with prostate biopsy has marked the modern age of prostate cancer diagnosis, which, unfortunately, has come with consequences such as incontinence and sexual dysfunction. 16 However, the impact of treating screen-detected low-grade tumors on the overall quality of life for men has been a point of contention in recent studies. 17,18 A diagnosis of prostate cancer also raises significant psychological distress, with several studies reporting minimum to severe anxiety associated with the PSA test.…”