@Article{,
AUTHOR = {Shahrokh F. Shariat, Peter T. Scardino, Hans Lilja},
TITLE = {Screening for prostate cancer: an update},
JOURNAL = {Canadian Journal of Urology},
VOLUME = {15},
YEAR = {2008},
NUMBER = {6},
PAGES = {4363--4374},
URL = {http://www.techscience.com/CJU/v15n6/62236},
ISSN = {1488-5581},
ABSTRACT = {The introduction of total prostate-specifi c antigen (tPSA) 
testing in serum has revolutionized the detection and 
management of men with prostate cancer. This review 
will highlight some of the exciting new developments in 
the fi eld of prostate cancer screening in general and from 
our SPORE research program at Memorial-Sloan Kettering 
Cancer Center. First, it is important to understand that the 
inherent variability of tPSA levels affects the interpretation 
of any single results. Total variation in tPSA includes both 
analytical (i.e., pre-analytical sample handling, laboratory 
processing, assay performance, and standardization) and 
biological variation (i.e., metabolism, renal elimination, 
medication, physical and sexual activity, size and integrity 
of the prostate). Second, recent evidence demonstrates that 
no single tPSA cut-off separates men at high risk for prostate 
cancer from men at low risk or men with “signifi cant” 
(high grade, high volume) cancer from those with low 
grade, indolent cancer. Taken together with a man’s age, 
family history, ethnicity, and digital rectal exam results, 
tPSA levels add to the overall estimate of the risk of cancer, 
allowing men to share in the decision about a biopsy. Third, 
men who will eventually develop prostate cancer have 
increased tPSA levels years or decades before the cancer is 
diagnosed. These tPSA levels may refl ect the long duration 
of prostate carcinogenesis and raise the question about a 
causal role for tPSA in prostate cancer development and 
progression. Total prostate-specifi c antigen measurements 
before age 50 could help risk stratify men for intensity of 
prostate cancer screening. Fourth, enhancing the diagnostic 
accuracy of tPSA, especially its specifi city, is of particular 
importance, since higher specifi city translates into fewer 
biopsies in men not affected by prostate cancer. While 
tPSA velocity has been shown to improve the specifi city 
of tPSA, its sensitivity is too low to avoid prostate biopsy 
in a patient with an elevated tPSA level. Moreover, 
prospective screening studies have reported that tPSA 
velocity does not add diagnostic value beyond tPSA level. 
At this time, tPSA velocity appears most useful after 
diagnosis and after treatment, but its value in screening and 
prognostication remains to be shown. Finally, while free PSA 
molecular isoforms and human kallikrein-related peptidase 
2 (hK2) hold the promise for detection, staging, prognosis, 
and monitoring of prostate cancer, evidence from large 
prospective clinical trials remain to be reported.},
DOI = {}
}