PSA and the family physician

The need for men to undergo screening for prostate cancer is controversial. Urologists are concerned about finding many men with minimal disease who may not require therapy or may be over-treated, while conversely missing men with clinically significant prostate cancer that could be treated and cured if found at an early enough stage. Most men today present to the physician with some symptoms attributable to the prostate, and then have a prostate-specific antigen (PSA) test to screen for prostate cancer. PSA is still the most effective test to suggest that there may be underlying prostate cancer. In addition to measuring total PSA, other measures such as PSA density, age-related PSA, or PSA velocity can provide further justification that a patient should undergo a prostate biopsy to detect possible cancer. The American Urological Association has developed new guidelines for screening for prostate cancer in men who are not at risk. The key is to use one of the PSA tools to help diagnose prostate cancer at an early stage and then offer aggressive curative therapy, if appropriate, while still providing the best quality of life and least chance of failure, in the right patient at the right time.