PSA test for detection of prostate cancer: should we perform it?

Abstract

PSA screening for the detection and treatment of prostate cancer raises controversies from many years. There is much discussions concerning the sensitivity and specificity of the test, the population-based effect and profit and loss account.Recently published results of randomized trials (ERSPC, PLCO) clarified the situation somewhat. It was a modest reduction in mortality from prostate cancer in the screened group treated with PSA, but this was not accompanied by the reduction in overall mortality. However, this was accompanied by significant costs in terms of complications after treatment, involving a serious threat to the life and deaths. In another study (PIVOT), prostatectomy dis not reduce mortality in the whole group, but a beneficial effect was observed only in patients with high PSA (over 10 ng/ml).Based on these reports, many authorities and medical scientific organizations recommend not to use the PSA test at all, or to limit it for men expressing clear preference, but only after presentation of the account of potential gains and losses. Attempts are being made to reduce the number of unnecessary medical intervention and the number of complications, such as less frequent testing and application of the PSA and the risk calculator. However, we have no reliable studies showing the impact of these changes on cancer-specific mortality, all-cause mortality and the number of adverse events.