Editorial Comment

Abstract

Due to the relatively modest survival benefit associated with the early detection of prostate cancer (PCa), prostate-specific antigen (PSA)-based screening has become controversial, with concerns regarding both overdiagnosis and overtreatment. 1 Kim E.H. Andriole G.L. Prostate-specific antigen-based screening: controversy and guidelines. BMC Med. 2015; 13: 61 Crossref PubMed Scopus (76) Google Scholar The authors of this manuscript attempt to consolidate the numerous disparate PSA screening recommendations into a unified guideline based on expert opinion informed by the best available data. 2 Vickers A.J. Eastham J.A. Scardino P.T. Lilja H. The Memorial Sloan Kettering Cancer Center recommendations for prostate cancer screening. Urology. 2016; https://doi.org/10.1016/j.urology.2015.12.054 Abstract Full Text Full Text PDF Scopus (49) Google Scholar The Memorial Sloan Kettering Cancer Center (MSKCC) recommendation for PCa screening begins at 45 years of age and provides a PSA-based risk-stratified algorithm: consider biopsy for those with PSA >3 ng/mL, routine screening for those with PSA between 1 and 3 ng/mL, and infrequent screening for those with PSA <1 ng/mL. Recommendations to begin testing at an earlier age and risk stratification according to PSA level were based in part on the Malmö Preventative Project study, 3 Lilja H. Cronin A.M. Dahlin A. et al. Prediction of significant prostate cancer diagnosed 20 to 30 years later with a single measure of prostate-specific antigen at or before age 50. Cancer. 2011; 117: 1210-1219 Crossref PubMed Scopus (116) Google Scholar whereas the threshold to consider biopsy and the screening interval of 2 to 4 years were based on the results of the European Randomized Screening for Prostate Cancer and the United States prostate, lung, colorectal, and ovarian cancer screening trials. 4 Schroder F.H. Hugosson J. Roobol M.J. et al. Screening and prostate cancer mortality: results of the European Randomised Study of Screening for Prostate Cancer (ERSPC) at 13 years follow-up. Lancet. 2014; 384: 6-12 Abstract Full Text Full Text PDF PubMed Scopus (1052) Google Scholar , 5 Andriole G.L. Crawford E.D. Grubb R.L. et al. Prostate cancer screening in the randomized prostate, lung, colorectal, and ovarian cancer screening trial: mortality results after 13 years of follow-up. J Natl Cancer Inst. 2012; 104: 1-8 Crossref Scopus (826) Google Scholar