Abstract
Purpose: To review current practice in the use of Prostate Specific Antigen (PSA) testing and assess the overall risks and benefits of PSA testing for Adenocarcinoma of the Prostate, specifically in men under age 65, and those living with risk factors for the disease. Materials and Methods: An extensive literature review of PSA testing in various age groups was conducted with the goal being to review PSA screening trends and assess current recommendations regarding PSA Screening for Adenocarcinoma of the Prostate in various age groups, focusing on studies directed towards patients under the age of 65 and the long-term risks and benefits of PSA screening in the diagnostic algorithm. In order to reduce bias, we assessed our sources for variables such as reporting, measurement and/or selection bias. Our conclusions were then compared with current recommendations. Relevant studies with data compiled after 2004, centered around PSA screening in men under the age of 65 in general and specifically in men with risk factors for developing Adenocarcinoma of the Prostate were included. Editorials, newspaper articles and other non-scholarly and non-peer reviewed sources were automatically excluded.
Highlights
Materials and Methods: An extensive literature review of Prostate Specific Antigen (PSA) testing in various age groups was conducted with the goal being to review PSA screening trends and assess current recommendations regarding PSA Screening for Adenocarcinoma of the Prostate in various age groups, focusing on studies directed towards patients under the age of 65 and the long-term risks and benefits of PSA screening in the diagnostic algorithm
Several risk factors for Adenocarcinoma of the Prostate have been identified, and while age, elevated Body Mass Indices (BMI), race, family history, hormone levels, environmental and genetic influences are all suspected to play a role in the development of disease, the only well-established risk factors are age, race/ethnicity, and family history of the disease.14While each individual risk factor is linked to specific associated increases in risk, it is likely that development of disease is due to the concurrent influence of multiple factors
Analysis of 2014 SEER data demonstrated that African-American men at the age of 40 - 49 years had higher Gleason score and 2.8 - 3.2 times higher mortality and metastatic disease compared with American men of European descent of the same age group [10]
Summary
Prostate Specific Antigen (PSA) is a serine protease glycoprotein in the human kallikrein family with a molecular weight of 33 kD, containing 7% carbohydrate. Since its clinical introduction in 1986, PSA-based screening for the early diagnosis of Adenocarcinoma of the Prostate has led to increased detection and incidence of disease, decreased age at the time of diagnosis, decreased grade and stage at the time of diagnosis, and decreased cause-specific mortality [2] [5] [6] [7] [8] [9]. According to multiple studies with relatively longer follow-up, there is a preponderance of evidence in favor of screening, especially in men aged 55 - 69 years It appears that patients who are asymptomatic but who are at increased risk of developing Prostate Cancer benefit from screening. Recognition of unique genetic factors in patients with early-onset disease coupled with aggressive behavior can help target screening and therapy and reduce disease-specific death among younger men
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