Background: Prostate cancer (PCA) is the most common type of cancer in men. The significant increase in incidence is most likely caused by the overdiagnosis of prostate cancer by widespread prostate-specific antigen (PSA) screening.
Objectives: This article reviews the three largest randomized trials of PSA-based prostate cancer screening and the benefits and disadvantages of general PSA screening. It gives an overview about the strategies to avoid the harms from overdetection and overtreatment without missing clinically relevant tumors.
Methods: This review article is based on a literature search in the PubMed database on PSA-based screening, molecular serum markers and risk-adapted PSA screening.
Results: In contrast to the CAP and PLCO trial, the ERSPC study reports a reduced relative and absolute mortality risk. Furthermore, the use of the PSA was associated with significantly lower risk of metastatic disease. In order to avoid unnecessary biopsy and overtreatment including treatment of insignificant prostate cancer, a number of tests have been proposed to improve the specificity of the PSA screening including the PHI, the 4Kscore and the risk-adapted PSA screening. The assessment of a baseline PSA level in the fifth decade allows subsequent risk-adapted PSA screening intervals. This concept is currently evaluated by the largest prospective multicenter trial, the PROBASE-trial.
Conclusions: Neither a complete rejection of a PSA-based screening nor a general PSA testing is a final solution to this dilemma. A risk-adapted PSA screening according to a baseline PSA as well as serum markers may reduce unnecessary diagnostic and therapeutic interventions and its attendant morbidities without a decrease in sensitivity.
Keywords: Early detection of cancer; Gleason score; Malignancy; Prostate cancer; Tumor markers.