[PSA screening 2013: background and perspectives]

Area of Science:

• Urology
• Preventive Medicine
• Oncology

Background:

• Prostate-specific antigen (PSA) screening remains a controversial topic in healthcare policy, unlike breast and colon screening.
• The debate necessitates a critical analysis of available data regarding PSA screening's benefits and drawbacks.
• Survival benefits of PSA screening are evident, particularly with extended follow-up periods.

Purpose of the Study:

• To critically analyze the data surrounding prostate-specific antigen (PSA) screening.
• To evaluate the impact of PSA screening on survival, overdiagnosis, and quality of life.
• To explore strategies for optimizing PSA screening protocols and patient management.

Main Methods:

• Analysis of data from studies like the European randomized screening study of prostate cancer (ERSPC).
• Examination of factors obscuring screening benefits, including prescreening, compliance issues, and biases.
• Assessment of the influence of screening population age and frequency on overdiagnosis and overtherapy.

Main Results:

• The ERSPC study demonstrated a statistically significant screening benefit for prostate cancer after 9-11 years (Evidence Level A).
• Overdiagnosis and overtherapy rates, ranging from 28-52%, negatively impact patient quality of life.
• PSA fine-tuning and risk stratification can potentially reduce unnecessary diagnoses and therapies by approximately one-third.

Conclusions:

• While PSA screening shows survival advantages, careful consideration of overdiagnosis and overtherapy is crucial.
• Implementing risk stratification and active surveillance for suitable tumors can mitigate adverse effects.
• Improving therapy quality and focusing on appropriate patient selection are key to maximizing screening benefits.