Strategy for detection of prostate cancer based on relation between prostate specific antigen at age 40-55 and long term risk of metastasis: case-control study
Screening for prostate cancer with the prostate specific antigen(PSA) test became widespread long before the availability of randomized evidence as to its value. There is now evidence that PSA screening is associated with reduced mortality from prostate cancer in men who would not otherwise be screened although
this comes at considerable harms in terms of the number of men who need to be screened, undergo biopsy, and be treated to prevent one man experiencing prostate cancer metastasis or dying.
That said, PSA screening is not a single intervention and men can be screened in different ways. There is surprisingly little evidence to support many aspects of contemporary screening guidelines. In particular, the age at which screening starts and the frequency of PSA testing is rarely justified in terms of empirical data. Recent evidence has suggested that a single PSA measurement can predict the long term risk of clinically relevant prostate cancer.3-6 This suggests that a baseline concentration could be used to determine whether a man might benefit from subsequent PSA tests and, if so, when these should be administered.