Screening for prostate cancer with prostate-specific antigen: beware the biases.
BACKGROUND
The evidence relating to the use of prostate-specific antigen (PSA) as a screening test is a highly controversial, as demonstrated by the lack of agreement among experts. There may be biases associated with various studies.


OBJECTIVE
The main controversy is the relatively high prevalence of prostate cancer (PC) found at autopsy compared with the relatively low death rate from the disease. The lack of modifiable risk factors has led to early detection as a strategy to reduce mortality, as there is evidence for a significant burden of disease. Important issues are the accuracy of current screening tests, some attempts to improve on them, and whether there are good prognostic markers. The consequences of PSA testing (usually further testing including biopsy) and outcomes of treatment are presented in terms of mortality and morbidity; quality of life (QOL) must also be considered. Also important are the benefits from, and the difficulties associated with the "informed choice" approach to PSA screening.


CONCLUSIONS
There is evidence to suggest that biases can have a significant impact on the utility of PSA as a screening test for PC.
Bunting
Peter S
PS
Gamma-Dynacare Medical Laboratories, 115 Midair Court, Brampton, Ontario, Canada L6T 5M3. buntingp@gamma-dynacare.com
D000367:Age Factors; D000368:Aged; D015982:Bias; D001706:Biopsy; D003951:Diagnostic Errors; D019317:Evidence-Based Medicine; D017408:Guidelines as Topic; D006801:Humans; D015994:Incidence; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D010808:Physical Examination; D011237:Predictive Value of Tests; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D012372:ROC Curve; D012016:Reference Values; D012307:Risk Factors; D012680:Sensitivity and Specificity
D017430:Prostate-Specific Antigen