Screening Test For Prostate Cancer Research Articles

Is the digital rectal exam any good as a prostate cancer screening test?

Is the digital rectal exam any good as a prostate cancer screening test?

Digital Rectal Examination Is Not a Useful Screening Test for Prostate Cancer

BackgroundAnnual digital rectal examination (DRE) is recommended as a stand-alone screening test for prostate cancer (PCa) in Germany for 45+ yr olds. DRE diagnostic performance in men as young as 45 yr old has not been proved by a screening trial. ObjectiveTo determine DRE diagnostic performance in a screening trial. Design, setting, and participantsThis analysis was conducted within the multicentric, randomized PROBASE trial, which enrolled >46 000 men at age 45 to test risk-adapted prostate-specific antigen (PSA) screening for PCa. Intervention(1) DRE was analyzed as a one-time, stand-alone screening offer at age 45 in 6537 men in one arm of the trial and (2) PCa detection by DRE was evaluated at the time of PSA-screen–driven biopsies (N = 578). Outcome measurements and statistical analysis(1) True-/false-positive detection rates of DRE as compared with PSA screening and (2) DRE outcome at the time of a prostate biopsy were evaluated. Results and limitations(1) A prospective analysis of 57 men with suspicious DRE at age 45 revealed three PCa. Detection rate by DRE was 0.05% (three of 6537) as compared with a four-fold higher rate by PSA screening (48 of 23 301, 0.21%). The true-positive detection rate by DRE relative to screening by PSA was 0.22 (95% confidence interval [CI] = [0.07–0.72]) and the false-positive detection rate by DRE was 2.2 (95% CI = [1.50–3.17]). (2) Among PSA-screen–detected PCa cases, 86% had unsuspicious DRE (sensitivity relative to PSA was 14%), with the majority of these tumors (86%) located in the potentially accessible zones of the prostate as seen by magnetic resonance imaging. ConclusionsThe performance of stand-alone DRE to screen for PCa is poor. DRE should not be recommended as a PCa screening test in young men. Furthermore, DRE does not improve the detection of PSA-screen–detected PCa. Patient summaryOur report demonstrated the poor diagnostic performance of digital rectal examination in the screening for prostate cancer in young men.

COVID-19 pandemic impact on screening and diagnosis of prostate cancer: a systematic review

IntroductionThe healthcare level has been greatly affected by the COVID-19 pandemic compared with before the outbreak. This study aimed to review the impact of COVID-19 on the screening and diagnosis...

Association between sulfur microbial diet and the risk of colorectal cancer precursors in older adults.

Sulfur microbial diet (SMD), related to the enrichment of sulfur-metabolizing gut bacteria, has been confirmed to be linked to an elevated risk of early-onset colorectal adenoma in young females. However, it remains unclear whether SMD is associated with the risk of colorectal adenoma in older people, who are at greater risk for colorectal cancer. All data on participants in this study were retrieved from the intervention arm of the Prostate, Lung, Colorectal, and Ovarian (PLCO) cancer screening test. Participants' adherence to this dietary pattern was assessed using SMD score. Hazard ratios (HR) and 95% confidence intervals (CI) were adopted in Cox proportional hazards regression models to assess the link between SMD score and the incidence of colorectal adenoma in participants included in the study. Specific stratified analyses were constructed to assess whether this association changed in different conditions, whereas the robustness of the association was examined through sensitivity analyses. The mean baseline age of participants was 62.1 (SD 5.2) years (range 54.0-75.0 years). During 19,468,589 person-years of follow-up, 992 colorectal adenoma cases were documented in a total of 17,627 included participants. In a fully adjusted model, an increased risk of colorectal adenoma was determined in participants in the highest quartile of SMD score in comparison with those in the lowest quartile (HRquartile4 vs. HRquartile1 = 1.23; 95% CI: 1.02, 1.47; p = 0.017 for trend). This positive association between SMD score and adenoma risk was more evident in participants who were current or former smokers (p = 0.029 for interaction). In this study, our results support a role for the SMD in the carcinogenicity of colorectal cancer precursors among older adults. Nevertheless, these results require validation through more research.

Eliciting preferences for cancer screening tests: Comparison of a discrete choice experiment and the threshold technique

ObjectiveTo compare results of three preference elicitation methods for a cancer screening test. MethodsParticipants (undergraduate students) completed a discrete choice experiment (DCE) and a threshold technique (TT) task. Accuracy (false positives, false negatives), benefits (lives saved), and cost for a cancer screening test were used as attributes in the DCE and branching logic for the TT. Participants were also asked a direct elicitation question regarding a hypothetical screening test for breast (women) or prostate (men) cancer without mortality benefit. Correlations assessed the relationship between DCE and TT thresholds. Thresholds were standardized and ranked for both methods to compare. A logistic regression used the thresholds to predict results of the direct elicitation. ResultsDCE and TT estimates were not meaningfully correlated (max ρ = 0.17). Participant rankings of attributes matched only 20% of the time (58/292). Neither method predicted preference for being screened (ps > 0.21). ConclusionsThe DCE and TT yielded different preference estimates (and rank orderings) for the same participant. Neither method predicted patients’ desires for a screening test. Practice implicationsClinicians, patients, policy makers, and researchers should be aware that patient preference results may be sensitive to the method of eliciting preferences.

Role of PSA Density and MRI in PSA Interpretation. Comment on Lumbreras et al. Variables Associated with False-Positive PSA Results: A Cohort Study with Real-World Data. Cancers 2023, 15, 261.

Prostate-specific antigen (PSA) has been utilized as a prostate cancer screening test for its high sensitivity for prostate cancer but is often criticized for its low specificity [...].

Awareness, knowledge, and factors that influenced the uptake of screening tests for prostate cancer among men aged 40 and older in Ido-Ekiti, Ekiti State, Nigeria.

Despite being the second most common and deadliest cancer in males, prostate cancer could go unnoticed in the early stages. Prevention programs have been set in place to help in the early detection and reduction of mortality rates in developed countries. The aim of this study was to determine awareness, knowledge, and the uptake of prostate cancer screening tests. Another objective was to identify the factors that determine the uptake of prostate cancer screening among men living in Ido-Ekiti. A cross-sectional study was conducted among males aged 40 and above living in Ido-Ekiti in Ido-Osi local government area, Ekiti State, Nigeria. The sample size of 380 respondents was obtained using Leslie Fisher's formula. The study revealed that the majority of the correspondents are aware of prostate cancer (57.9%). More than two-thirds of the respondents have poor knowledge of prostate cancer and the screening test (74.4%), with a median knowledge score of 30%. The uptake of prostate cancer screening tests was very low among the respondents (18.2%). Despite the high level of awareness of prostate cancer disease among the respondents, the majority have poor knowledge of the disease and the screening test. There was a low uptake of prostate cancer screening tests among the respondents.

PROSTATE CANCER: KNOWLEDGE, ATTITUDE AND SCREENING PRACTICES AMONG MALE CIVIL SERVANTS IN LAGOS STATE, SOUTH-WESTERN, NIGERIA

Background: Prostate cancer is the most commonly diagnosed malignancy among men and the sixth leading cause of cancer-related mortality among men worldwide. The aim of this study is to determine the knowledge, attitude and practice of prostate cancer screening among male civil servants in Lagos state, Nigeria Methods: A descriptive cross-sectional study was conducted using a pretested, structured, self-administered questionnaires. Multi-stage sampling technique was used to select 250 respondents. Responses to the knowledge and attitude questions were scored and graded as poor (<50%) and good (?50%). The mean knowledge and attitude scores were also determined. Univariate and bivariate analysis were carried out. P value?0.05 was considered statistically significant. Results: The mean age and age range of the respondents were 43.06 ± 8.22 years and 20-59 years respectively. Only 75(31.12%) of the respondents had good knowledge of prostate cancer. The mean knowledge score (%) was 31.54±20.91. There was a statistically significant relationship (p?0.05) between respondents' monthly income and knowledge of prostate cancer. Attitudes toward prostate cancer screening were good among 225(93.36%) of the respondents. Mean attitude score (%) was 69.46±12.57. There was a statistically significant association (p?0.05) between respondents' level of education and attitudes toward prostate cancer screening. Only 59(24.48%) of the respondents have ever done prostate cancer screening test. There was a statistically significant relationship (p?0.05) between respondents' monthly income and practice of prostate cancer screening. Conclusion: Knowledge and practice of prostate cancer screening is poor even among seemingly educated people. Health education campaigns utilizing the electronic media should be conducted regularly by Lagos state ministry of health to increase awareness among civil servants in Lagos state. Keywords: Prostate cancer, screening, knowledge, attitu

Financial Toxicity and Its Association With Prostate and Colon Cancer Screening.

The term "financial toxicity" or "hardship" is a patient-reported outcome that results from the material costs of cancer care, the psychological impacts of these costs, and the coping strategies that patients use to deal with the strain that includes delaying or forgoing care. However, little is known about the impact of financial toxicity on cancer screening. We examined the effects of financial toxicity on the use of screening tests for prostate and colon cancer. We hypothesized that greater financial hardship would show an association with decreased prevalence of cancer screening. This cross-sectional survey-based US study included men and women aged ≥50 years from the National Health Interview Survey database from January through December 2018. A financial hardship score (FHS) between 0 and 10 was formulated by summarizing the responses from 10 financial toxicity dichotomic questions (yes or no), with a higher score associated with greater financial hardship. Primary outcomes were self-reported occurrence of prostate-specific antigen (PSA) blood testing and colonoscopy for prostate and colon cancer screening, respectively. Overall, 13,439 individual responses were collected. A total of 9,277 (69.03%) people had undergone colonoscopies, and 3,455 (70.94%) men had a PSA test. White, married, working men were more likely to undergo PSA testing and colonoscopy. Individuals who had not had a PSA test or colonoscopy had higher mean FHSs than those who underwent these tests (0.70 and 0.79 vs 0.47 and 0.61, respectively; P≤.001 for both). Multivariable logistic regression models demonstrated that a higher FHS was associated with a decreased odds ratio for having a PSA test (0.916; 95% CI, 0.867-0.967; P=.002) and colonoscopy (0.969; 95% CI, 0.941-0.998; P=.039). Greater financial hardship is suggested to be associated with a decreased probability of having prostate and colon cancer screening. Healthcare professionals should be aware that financial toxicity can impact not only cancer treatment but also cancer screening.

Early Detection of Prostate Cancer: Self-Reported Knowledge and Attitude of Physicians in Jordan

Prostate cancer (PC) screening aims to detect PC in early stages, amenable to curative treatment and reduction in disease morbidity and mortality. However, PC screening may be associated with overdiagnosis and complications of unnecessary treatment for indolent disease. Therefore, careful patient selection for PC screening is critical to avoid overestimation and missed diagnosis. The aim of this study was to assess physicians’ knowledge and attitude towards early detection of PC in Jordan and whether their knowledge is an important predictor of their attitude. An electronic, self-reported questionnaire was used to collect data on demographics, knowledge, and attitude of physicians regarding early detection of PC. The participants’ responses were analyzed using descriptive statistics and multiple linear regression. Around 296 physicians agreed to participate in this study. Most respondents were males (75.7%), residents (34%), practiced medicine more than 15 years (29%) and graduated (81.4%) from local universities. Surprisingly, only 28.4% recognized PC as a non-self-detected disease and less than one-half (48.6%) were aware that PC screening tests are not enough to exclude a diagnosis of PC. The median knowledge Percent of Maximum Possible (POMP) score was 59%. Around two-thirds of participants showed a positive attitude towards early detection of PC (median attitude POMP score was 66%). Higher attitude scores were significantly associated with younger age, those working in private hospitals, and those having higher knowledge POMP score (P < .05). This study highlighted that most physicians demonstrated a positive attitude towards PC screening but with moderate level of knowledge that is considered an important predictor of their attitude towards PC early detection. Thus, improving knowledge and awareness of physicians should be considered as a strategy to improve their attitude towards prostate screening practices and informing men of the importance of regular screening.

Awareness about prostate cancer and its screening in Medina, Jeddah, and Makkah, Saudi Arabia population.

Background:Prostate cancer (PCa) is a global burden on public health; it has been ranked as the second common cancer worldwide, with 1.3 million new cases in 2018. Developed countries have a higher incidence than in developing countries. Because of the lack of studies on PCa in Saudi Arabia, our study aims to measure the awareness about PCa and knowledge of PCa screening practices among men in Medina, Jeddah, and Makkah, Saudi Arabia.Methodology:A cross-sectional study conducted among males in Medina, Jeddah, and Makkah, Saudi Arabia, from 2nd to 10th July 2020, using a validated questionnaire. The sample size was 1212 participants. Data collected through an online questionnaire. All data analyses performed using (SPSS) software, using the Chi-square test for bivariate analysis. All levels of significance were set at P < 0.05.Results:We collected 1212 completed surveys, with mean ages of 36 years (standard deviation ± 12.77). We found that 77% of participants heard about PCa, and 52.5% heard about PCa screening tests. This study showed that only 10.6% of all participants had good knowledge, 41.9% had fair knowledge, and 47.5% had poor knowledge. Only 3.9% of participants had experienced the prostate-specific antigen test.Conclusion:The study showed that the level of knowledge of PCa is low. Thus, community and individuals should collaborate to increase awareness by having more awareness campaigns, disseminating the information through the media, and encouraging men to do screening tests as indicated. In addition, including more Saudi Arabia cities in future studies is preferable to have more precise outcomes.

Knowledge, preferences and willingness to use at-home prostate and colorectal cancer screening tests in African American and Haitian men.

Haitian (HA) and African American (AA) men have the highest prostate cancer (PCa) and colorectal cancer (CRC) age-adjusted mortality rates compared with other racial/ethnic groups worldwide. One contributing factor to mortality differences is that a low percentage of age-eligible HA and AA men screen for PCa and CRC, even when healthcare access and insurance are available. Reasons for cancer screening disparities may be differences in knowledge, preferences and willingness in HA and AA men. However, limited information exists on whether HA and AA men are knowledgeable about and are willing to be screened for PCa and CRC. Moreover, understanding preferences and willingness of HA and AA men to use cancer screening tests completed at home is of paramount importance given the current pandemic. We used a cross-sectional study design to assess HA and AA men’s knowledge, preferences and willingness to use at-home PCa and CRC screening tests. Survey items were developed from existing surveys assessing CRC knowledge and willingness to screen. Institutional Review Board approval was obtained to invite persons who identified as male, at least 18 years of age and Black (as either AA and/or HA) to complete the survey. A total of 36 Black men completed the survey; 42% self-identified as both ‘African American’ and ‘Haitian’ (AA/HA), 44% identified only as AA, and 14% identified only as HA. Regardless of race or ethnicity, 75% of all participants were 45 years or younger (range: 18–85). Although more than 80% of all participants heard about PCa and CRC, only 50% of participants aged at least 50 years old were screened for CRC. The majority of participants (AA/HA = 67%; HA = 80%; AA = 56%) were unaware of at-home CRC screening tests; however, 80% of AA/HA men and 60% of HA men were willing to use an at-home CRC screening test compared to 44% of AA men.

Plasmatic Exosome Number and Size Distinguish Prostate Cancer Patients From Healthy Individuals: A Prospective Clinical Study.

There is a urgent need for valuable strategy in early and less invasive diagnosis for cancer. Preliminary data have shown that the plasmatic levels of exosomes increase in cancer condition. This study investigates the relevance of plasmatic levels and size distribution of exosomes in 42 individuals with no signs of urological disease (CTR) as compared to 65 prostate cancer patients (PCa). It was used Nanoparticle Tracking Analysis (NTA), a highly reliable and sensitive method for exosomes characterization and quantification. The relation structure among the NTA-derived parameters was assessed by means of Principal Component Analysis, which allowed detecting the global discriminant power of NTA test in terms of Receiver Operating Characteristic (ROC) curve and the selection of cut-off thresholds. The results showed that PCa had significantly higher plasmatic levels of exosomes and that the exosomes were smaller in size as compared to the CTR; the values reached 89% sensitivity and 71% specificity, in distinguishing PCa from CTR. These results propose a new exosome-based non-invasive clinical approach for the clinical follow-up of prostate cancer undergoing surgical treatment; in addition this method may be developed as a new screening test for prostate cancer’s early diagnosis. While this clinical study was performed in prostate cancer, it may represent a proof of concept extendable to virtually all cancers, as it is suggested by both pre-clinical evidence and clinical data obtained with different technical approaches.

Digital rectal examination in prostate cancer screening at PSA level 3.0-3.9 ng/ml: long-term results from a randomized trial

Objective To evaluate digital rectal examination (DRE) as a predictor of prostate cancer (PC) at serum PSA level 3.0–3.9 ng/ml. We compared the PC incidence rates of men with different screening test results in this PSA range and analyzed DRE in comparison with free/total PSA ratio as an additional screening test. Materials and methods Using data from the FinRSPC trial, PC incidence rate ratios (IRR) for groups defined by the secondary screening test results (DRE vs. free/total PSA) were calculated for 17-year follow-up, using adjustment for age, family history of PC and place of residence. Screening test performance was evaluated by calculating sensitivity, specificity, positive and negative predictive value, and likelihood ratio. Results The IRR for men with a positive DRE compared to those with a negative result was 1.40 (95% confidence interval (CI) 1.00–1.96), while the IRR for men with a positive free/total PSA result compared to those with a negative one was 1.62 (95% CI 1.08–2.43). The estimated sensitivity was 0.15 (95% CI 0.11–0.20, 40/270) for DRE and 0.32 (95% CI 0.23–0.41, 36/113) for free/total PSA, and the specificity 0.91 (95% CI 0.88–0.93, 419/461) for DRE and 0.85 (95% CI 0.78–0.90, 134/158) for free/total PSA. Conclusions Our results do not support utility of DRE as a screening test for PC at serum PSA level 3.0–3.9 ng/ml, while the results regarding free/total PSA determination were more encouraging and reconfirm the decision to switch from DRE to free/total PSA.

Awareness and knowledge about prostate cancer among male teachers in the Sunyani Municipality, Ghana

The study was aimed at assessing the awareness and knowledge of prostate cancer (PC) among male teachers in the Sunyani municipality of Ghana. This was a cross-sectional study conducted using a structured questionnaire to collect data from 160 male teachers aged 45 years or more, randomly selected from public elementary and high schools in the Sunyani Municipality. Pearson's Chi square and Fishers exact tests were used to examine the association between socio-demographic characteristics and knowledge of PC. On average, respondents were aged 50±3.95 years. There was a universal awareness of PC. Most of the respondents could identify at least one signs and symptoms of PC (88.1%), risk factors of PC (78.8%), and indicated that PC could be treated through surgery (70.6 %), but only 37.5% of respondents knew about screening tests for PC. The study found 57.5% of them had adequate knowledge about PC. Socio-demographics characteristics were not associated with knowledge about PC. Main sources of information were the television (68%) and radio (57 %). The outcomes of the study suggest the need for general educational campaigns with emphasis on modalities for the screening of PC using the appropriate media channels for accessibility.

Decision fatigue in low-value prostate cancer screening.

Low-value prostate-specific antigen (PSA) testing is common yet contributes substantial waste and downstream patient harm. Decision fatigue may represent an actionable target to reduce low-value urologic care. The objective of this study was to determine whether low-value PSA testing patterns by outpatient clinicians are consistent with decision fatigue. Outpatient appointments for adult men without prostate cancer were identified at a large academic health system from 2011 through 2018. The authors assessed the association of appointment time with the likelihood of PSA testing, stratified by patient age and appropriateness of testing based on clinical guidelines. Appointments included those scheduled between 8:00am and 4:59pm, with noon omitted. Urologists were examined separately from other clinicians. In 1,581,826 outpatient appointments identified, the median patient age was 54years (interquartile range, 37-66years), 1,256,152 participants (79.4%) were White, and 133,693 (8.5%) had family history of prostate cancer. PSA testing would have been appropriate in 36.8% of appointments. Clinicians ordered testing in 3.6% of appropriate appointments and in 1.8% of low-value appointments. Appropriate testing was most likely at 8:00am (reference group). PSA testing declined through 11:00am (odds ratio [OR], 0.57; 95% CI, 0.50-0.64) and remained depressed through 4:00pm (P<.001). Low-value testing was overall less likely (P<.001) and followed a similar trend, declining steadily from 8:00am (OR, 0.48; 95% CI, 0.42-0.56) through 4:00pm (P<.001; OR, 0.23; 95% CI, 0.18-0.30). Testing patterns in urologists were noticeably different. Among most clinicians, outpatient PSA testing behaviors appear to be consistent with decision fatigue. These findings establish decision fatigue as a promising, actionable target for reducing wasteful and low-value practices in routine urologic care. Decision fatigue causes poorer choices to be made with repetitive decision making. This study used medical records to investigate whether decision fatigue influenced clinicians' likelihood of ordering a low-value screening test (prostate-specific antigen [PSA]) for prostate cancer. In more than 1.5 million outpatient appointments by adult men without prostate cancer, the chances of both appropriate and low-value PSA testing declined as the clinic day progressed, with a larger decline for appropriate testing. Testing patterns in urologists were different from those reported by other clinicians. The authors conclude that outpatient PSA testing behaviors appear to be consistent with decision fatigue among most clinicians, and interventions may reduce wasteful testing and downstream patient harms.

Is PSA density of the peripheral zone as a useful predictor for prostate cancer in patients with gray zone PSA levels?

BackgroundSerum prostate-specific antigen (PSA) is widely used in screening tests for prostate cancer. As the low specificity of PSA results in unnecessary and invasive prostate biopsies, we evaluated the clinical significance of various PSAs and PSA density (PSAD) related to peripheral zones in patients with gray zone PSA level (4–10 ng/mL).MethodsA total of 1300 patients underwent transrectal ultrasonography-guided prostate biopsy from 2014 to 2019. Among them, 545 patients in the gray zone were divided into the prostate cancer diagnosis group and the non-prostate cancer diagnosis group, and PSA, relative extra transitional zone PSA (RETzPSA), estimated post holmium laser enucleation of the prostate PSA (EPHPSA), PSAD, peripheral zone PSA density (PZPSAD) and extra-transitional zone density (ETzD) were compared and analyzed using receiver-operating characteristics (ROC) analysis after 1:1 matching using propensity score.ResultsArea under the ROC curve values of PSA, EPHPSA, RETzPSA, PSA density, ETzD, and PZPSAD were 0.553 (95% CI: 0.495–0.610), 0.611 (95% CI: 0.554–0.666), 0.673 (95% CI: 0.617–0.725), 0.745 (95% CI: 0.693–0.793), 0.731 (95% CI: 0.677–0.780) and 0.677 (95% CI: 0.611–0.719), respectively. PSAD had 67.11% sensitivity, 71.71% specificity, and 70.34% positive predictive rate at 0.18 ng/mL/cc. ETzD had 69.08% sensitivity, 64.47% specificity, and 66.04% positive predictive rate at 0.04 ng/mL/cc. When the cut-off value of PSAD was increased to 0.18 ng/mL/cc, the best results were obtained with an odds ratio of 5.171 (95% CI: 3.171–8.432), followed by ETzD with 4.054 (95% CI: 2.513–6.540).ConclusionsThese results suggested that volume-adjusted parameters (ETzD and PSAD) might be more sensitive and accurate than various PSA in gray zone patients who required prostate biopsy to reduce unnecessary biopsy.

The level of knowledge and awareness of male university personnels about adult cancers and cancer screening.

Objective: Cancer incidence rates have been increasing for both genders. The first aim was to determine the knowledge level of men about the types of cancers on adults. The second aim was to assess the level of knowledge of them on cancer screening programs. Method: This cross-sectional study was conducted at Karabük University in 2020, with 312 males who worked as academicians, administrative personnel and contract-labor. A questionnaire on sociodemographic characteristics and the knowledge of male employees about cancer and cancer screenings was applied to the participants by interviewing in the university. Results: The mean age of male participants was 40 years. Of the participants, 39.7% knew that lung cancer is the most common type of cancer among men while 80.4% knew that breast cancer is the most common type of cancer among women. Of the participants, 42.9% heard of the Center of Early Detection and Screening of Cancer (CEDSC) and only 12.5% had a cancer screening test. The participants’ answers to the question “Which cancer screening tests are made in CEDSC?” were breast cancer (55.8%), cervical cancer (35.6%), colorectal cancer (31.1%) and prostate cancer (26.0%). Mammography was the most well-known among screening tests (51.9%). The level of knowledge on colon, cervical and prostate cancer screening tests increased with age (p&amp;lt;0.05). Conclusion: The level of knowledge about cancer and cancer screenings of male participants was mostly moderate. It might be possible to increase the level of knowledge on cancer and cancer screening of men by preparing educative and informative programs.

Relevance of nationwide prostate specific antigen screening test for prostate cancer

The serum prostate specific antigen (PSA) screening test plays a pivotal role in the diagnosis of prostate cancer (PCa), especially for early detection, before symptoms of systemic spread. Even though clinical trials for the PSA screening test have demonstrated limited benefits with regard to patient survival, recent trends have shown a continuous decrease in the PCa mortality rate in Western countries. In many Asian countries where PSA screening has not yet been widely adopted, the screening strategy reduces the metastatic spread. While PCa became the 10th most common malignant disease in the Korean male population in 2000, recent national reports indicate that its increase in the last two decades have now made it the third most popular malignant condition. Due to the different epidemiologic background and limited social awareness of PCa compared to Western countries, the PSA screening test was not routinely performed in Korea, in contrast with other prevalent malignant diseases such as stomach, colon, and lung cancers. Therefore, only about a quarter of the patients newly diagnosed with PCa in Korea were found to have undergone repeated PSA screening. However, the screened population showed a higher probability of local rather than systemic treatment, which reflects an earlier disease stage at the time of diagnosis in comparison with their non-screened counterparts. Given the relatively high survival rate of PCa and the increasing lifespan of Korean males, the increase of PCa will accelerate, suggesting the clinical relevance of PSA screening as part of regular checkups for Korean males.

Rethinking prostate cancer screening: could MRI be an alternative screening test?

In the past decade rigorous debate has taken place about population-based screening for prostate cancer. Although screening by serum PSA levels can reduce prostate cancer-specific mortality, it is unclear whether the benefits outweigh the risks of false-positive results and overdiagnosis of insignificant prostate cancer, and it is not recommended for population-based screening. MRI screening for prostate cancer has the potential to be analogous to mammography for breast cancer or low-dose CT for lung cancer. A number of potential barriers and technical challenges need to be overcome in order to implement such a programme. We discuss different approaches to MRI screening that could address these challenges, including abbreviated MRI protocols, targeted MRI screening, longer rescreening intervals and a multi-modal screening pathway. These approaches need further investigation, and we propose a phased stepwise research framework to ensure proper evaluation of the use of a fast MRI examination as a screening test for prostate cancer.