Prostate-Specific Antigen Screening in Prostate Cancer: Perspectives on the Evidence

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Introduction: The State of the Evidence

Ethan Basch

Despite multiple prospective clinical trials, observational studies, retrospective analyses, and simulation models, intense controversy persists regarding the value of screening for prostate cancer with the prostate-specific antigen (PSA) test. Similar data have been used to draw conflicting conclusions, and clinical practice guidelines appear discordant on the merits of screening ( 1–4 ).

Where are the areas of guideline agreement? There is general consensus that there is limited or no benefit of PSA screening among older men (ie, those aged ≥70 or 75 years) or those with limited life expectancy (ie, <10–15 years). There is agreement that there are real harms associated with downstream clinical actions taken in response to PSA screening. And there is agreement that there is overtreatment of low-grade tumors once discovered, with growing encouragement to pursue programs of active surveillance in such men, with nascent but expanding evidence in this area ( 5 ). For men considering PSA screening, an informed discussion with their provider is universally advised.