Should prostate-specific antigen screening be offered to asymptomatic men?

Abstract

The benefits of population-based prostate cancer screening are the detection of clinically important prostate cancers at an early, still curable, stage and the subsequent reduction of prostate cancer-specific mortality. However, a prostate-specific antigen (PSA)-based prostate cancer screening program is currently insufficient to warrant its introduction as a public health policy. The main reasons are insufficient knowledge regarding the optimal screening strategy and overdiagnosis and overtreatment of indolent prostate cancers that are unlikely to lead to complaints or death. In some countries, guidelines have been developed on screening for prostate cancer, but the diversity of recommendations illustrates the limited knowledge on the optimal strategy. Therefore, men should be well informed about the benefits and potential harms of PSA screening in order to enable them to make an informed decision. Although a mortality reduction can be achieved by early detection of prostate cancer, patients and physicians must be aware of the current side effects of screening. Algorithms that advise screening at a young age (<55 years), with screening intervals of less than 4 years and low PSA thresholds (<3 ng/ml) for prostate biopsy seem premature and are not supported by evidence.

Keywords::

• guideline
• informed decision making
• nomogram
• prostate cancer
• prostate cancer risk strategy
• prostate-specific antigen screening

Financial & competing interests disclosure

The European Randomized Study of Screening for Prostate Cancer (ERSPC) is funded by grants of the Dutch Cancer Society, The Netherlands Organization for Health Research and Development, The Prostate Cancer Research Foundation Rotterdam the Netherlands, European Union Grants, the 6th Framework Program of the EU: P-Mark, and Beckman-Coulter-Hybritech Inc. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.