Prostate-Specific Antigen-Based Prostate Cancer Screening

Serum prostate-specific antigen (PSA) testing is a simple and effective method for diagnosing prostate cancer. The widespread PSA screening resulted in increased diagnosis of early-staged, localized prostate cancer and marked reduction in advanced, metastatic cancer, which contributed to subsequent reduction in prostate cancer mortality. Most patients with localized prostate cancer, especially low-grade cancer, have an indolent clinical course. In addition, the rate of death from prostate cancer itself is very low. Therefore, early diagnosis of prostate cancer can lead to overdiagnosis and overtreatment. There has been a controversy regarding the effect of PSA screening on prostate cancer mortali‐ ty. Results of the two largest randomized trials concerning PSA screening were totally contrary. European countries-based trial showed a significant prostate cancer mortality reduction, whereas the USA-based trial showed no benefit in reducing prostate cancer mortality. In 2013, based on these arguments, the American Urological Association updated a guideline regarding PSA screen‐ ing, which did not recommend routine PSA screening but a selective screen‐ ing, according to patient's age, coexisting medical condition, and risks, such as family history. The guideline also emphasized shared decision making. However, older patients have been shown to be more likely to have high-risk prostate cancer at diagnosis. Older patients more often have other medical conditions and are more likely to die from causes other than prostate cancer. Prostate cancer is more often diagnosed with older patients. These facts bring PSA-based screening for prostate cancer more and more complex. In this chapter, problems concerning PSA screening are presented.