Open Access

ARTICLE

Prostate-specifi c antigen tests and prostate cancer screening: an update for primary care physicians

John S. Kell

Division of Urology, Toronto East General Hospital, Toronto, Ontario, Canada
Address correspondence to Dr. John S. Kell, Toronto East General Hospital, Division of Urology, 840 Coxwell Avenue, Suite 302, Toronto, Ontario M4C 5T2 Canada

Canadian Journal of Urology 2010, 17(Suppl.1), 18-25.

Abstract

Prostate cancer is a highly prevalent malignancy. Using serum prostatic-specifi c antigen (PSA) levels to screen for prostate cancer has led to a greater detection of this cancer, at earlier stages. However, screening for prostate cancer by determining PSA levels remains controversial. Concerns include the risk of overdiagnosis and conversely, the failure to detect all prostate cancers. This article, aimed at primary care practitioners, reviews the characteristics of an ideal screening test, in relation to the characteristics of the PSA test. It then discusses the implications of recent fi ndings from two large, randomized, prospective screening trials: the American Prostate, Lung, Colorectal and Ovarian Cancer (PLCO) screening trial and the European Randomized Study of Screening for Prostate Cancer (ERSPC) trial. The latter trial demonstrated a modest survival benefi t from PSA screening. Lastly, the article summarizes recommendations from recently updated guidelines about PSA testing from the American Urological Association (AUA), and it discusses when a primary care practitioner might refer a patient to a urologist.

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Keywords

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