Abstract
Prostate cancer (PCa) is the most common cancer type in men. Overall, the goal of prostate-specific antigen (PSA)-based screening is to identify early-stage disease that can be treated successfully. However, evidence supporting an overall survival advantage in men undergoing PSA screening is controversial, leading to a lack of consensus on guidelines. The present review article provides an overview of the most important studies on PSA screening including the latest updates of large trials. In addition, modern concepts in early detection of PCa that can be added to PSA measurement alone such as PSA isoforms or mpMRI are discussed. Lastly, recommendations for PCa screening and early detection from the European and German Societies of Urology issued in 2019 are presented.
Highlights
Prostate cancer (PCa) is the most common cancer and remains an important cause of death in males [1]
prostate-specific antigen (PSA) itself occurs in several different molecular forms in serum: free PSA and complexed PSA
Using a microsimulation model, the ERSPC investigators were able to demonstrate that ERSPC would have shown only a slightly larger PCa mortality reduction if all centers had complied with the quality criteria for attendance or biopsy compliance [8]
Summary
Received: 19 August 2019 / Accepted: 21 August 2019 / Published online: 28 August 2019. Prostate-specific antigen (PSA) remains the most used biomarker in the detection of early PCa [2]. PSA is a serine protease produced and released by epithelial cells of the prostate. PSA itself occurs in several different molecular forms in serum: free PSA (fPSA) and complexed PSA (total PSA; [2, 3]). It has been demonstrated in large patient cohorts that regular PSA measurement reduces PCa mortality rates, PSA screening is still a controversial issue in most countries because beside the benefits there are harms such as overdiagnosis and overtreatment. Keywords Prostate cancer · PSA · Early detection · PSA isoforms · mpMRI · Guidelines
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