What should doctors say to men asking for a PSA test?

Abstract

Patients need individual discussions about the benefits and harms of testing

Predicting High-Risk Prostate Cancer Using Machine Learning Methods

“…Nonetheless, Figure 4 indicates that these sampling methods increase the AUC, suggesting we should hold onto them. This is in line with what you would expect from an imbalance correction method, but it does reflect that further optimization needs to be done, especially as false positives are currently a problem with PSA tests [5]. predictor performed the best in terms of every metric shared between all the predictors aside from specificity, with its specificity being 0.0095 less than that of our PoHRPC predictor.…”

“…One very common screening method is the measurement of prostate-specific antigen (PSA), which is a protein produced by cells of the prostate gland. However, it has been shown that monitoring PSA levels has no significant impact on prostate cancer mortality after a median follow-up of 10 years with those who had this monitoring [4,5]. The United States Preventative Services Task Force (USPSTF) originally issued a recommendation against PSA screening for all ages in 2012 [6], but in 2017 revised that recommendation to say that the decision to undergo PSA testing is an individual decision for men between 55 and 69 years of age, with those over 70 still being recommended against PSA screening [1].…”

“…Negoita et al find that decrease in PSA screening following the aforementioned USPSTF recommendations has led to a flattening off of mortality, although this could be due to other factors, and has also led to a higher incidence of late stage disease [8]. Martin et al see promise in developing "better screening tests (including free (unbound) PSA and biochemical and genetic markers), clear protocols for active surveillance, better focal treatments for localized diseases, and better treatments for advanced cancer" [5]. The defects in PSA screening thus warrant investigation into new screening methods.…”

The elusive diagnosis of cancer: testing times

“…3 Over half of UK hospitals now use multiparametric-MRI to protect men from the harms of unnecessary biopsy and treatment for indolent prostate cancer. 4 The important question Just and colleagues raise is not which test should be performed once a patient is referred for suspected prostate cancer, but rather should patients with non-specific symptoms be tested in primary care and are there harms of testing them?…”

Systematic Review & Meta-Analysis of the Diagnostic Accuracy of Prostate Specific Antigen (PSA) for the Detection of Prostate Cancer in Symptomatic Patients

“…Primary care clinicians are generally aware of the limitations of PSA testing (39), and clinical guidelines encourage a balanced discussion with patients of the potential bene ts and harms of relying on PSA to detect prostate cancer (40,41). The ndings of this review suggest this is a pragmatic approach in providing care to patients with LUTS.…”