[Prostate cancer and prostate specific antigen screening]

Prostate cancer diagnosis by prostate specific antigen (PSA) test is so popular and widespread that becomes a routine mass screening. The screening efficacy has not yet been proved and today remains a controversial topic. The author discusses about present arguments in support and in opposite to the use of PSA screening. Waiting for definitive results of the efficacy of PSA screening from randomised trials, the author shows what may be useful to do in clinical routinary practice with PSA test. Since PSA is tissue specific and not cancer specific, very often further unnecessary investigations such as prostate biopsy are required. To reduce false positive and false negative results of the PSA test and to indicate which men with negative prostate biopsy need rebiopsy, new methods improving specificity and sensibility of PSA test have been proposed. To clarify these improving PSA test methods, the author analyses each method showing limits and performances. New molecular forms of PSA (PSA isoforms) circulating in peripheral blood are also evaluated.