title: Prostate-specific antigen tests and prostate cancer screening: an update for primary care physicians.
abstract: Prostate cancer is a highly prevalent malignancy. Using serum prostatic-specific 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 findings 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 benefit 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.
authors.affiliation: Division of Urology, Toronto East General Hospital, Toronto, Ontario, Canada.
authors.forename: John S
authors.initials: JS
authors.lastname: Kell
mesh_terms: D017677:Age Distribution; D000368:Aged; D001291:Attitude of Health Personnel; D002170:Canada; D055088:Early Detection of Cancer / Q000592:standards / Q000639:trends; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D010821:Physicians, Family / Q000639:trends; D010818:Practice Patterns, Physicians'; D015995:Prevalence; D011320:Primary Health Care / Q000379:methods* / Q000639:trends; D011379:Prognosis; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D015996:Survival Rate
chemical_list: D017430:Prostate-Specific Antigen