Prostate-specific antigen-based prostate cancer screening: Past and future.

Area of Science:

• Urology
• Oncology
• Public Health

Background:

• Prostate-specific antigen (PSA) screening for prostate cancer is controversial.
• Population-based screening harms, primarily from overdiagnosis, often outweigh benefits.
• Opportunistic screening is widespread despite these concerns.

Purpose of the Study:

• To analyze the benefits and harms of PSA-based prostate cancer screening.
• To emphasize the need for individualized screening approaches.
• To discuss future research directions for optimizing screening.

Main Methods:

• Review of existing data, including the European Randomized Study of Screening for Prostate Cancer.
• Analysis of overdiagnosis as a consequence of screening.
• Discussion of shared decision-making in current screening practices.

Main Results:

• PSA-based screening demonstrated a reduction in prostate cancer mortality in population-based studies.
• Overdiagnosis of clinically insignificant tumors remains a significant issue.
• Current evidence suggests a need to move beyond population-based recommendations.

Conclusions:

• Individualizing screening decisions is crucial to maximize benefits and minimize harms.
• Shared decision-making is recommended in the absence of a more optimal screening strategy.
• Future research should focus on improved biomarkers and multiparametric MRI to reduce unnecessary testing and overdiagnosis.