Chapter 13 - Prostate-Specific Antigen Screening Guidelines

Abstract

The introduction of prostate-specific antigen (PSA) testing in 1986 dramatically increased the incidence of prostate cancer such that it is now the most commonly diagnosed cancer in the industrialized world. While PSA testing can detect prostate cancers at an early localized stage, screening for prostate cancer has generated considerable controversy because of the uncertainty surrounding its ability to lower prostate cancer mortality. PSA testing leads to overdiagnosis and overtreatment of this disease, resulting in significant detrimental physical, psychological, and financial consequences. In 2013 the United States Preventive Services Task Force (USPSTF) recommended against PSA testing because the harms of testing appear to outweigh the benefits. The American Urological Association developed new guidelines for the early detection of prostate cancer to balance reduction in prostate cancer mortality against the harms associated with screening. This chapter reviews evidence concerning the benefits and harms of PSA testing for prostate cancer.