[PROSTATE CANCER EARLY DETECTION USING PSA - CURRENT TRENDS AND RECENT UPDATES]

Prostate cancer (Pca) is the most common malignancy in men and the second cause of death from cancer. The prostate specific antigen (PSA) assay has been used for Pca screening since the beginning of the 1990's and has brought a 40% reduction in mortality. Since Pca is a diverse disease, early detection can lead to overdetection and overtreatment. Pca treatment has significant adverse effects, namely incontinence and erectile dysfunction. How is it then that a simple and inexpensive test that probably caused the most significant reduction in mortality from cancer ever, is regarded to be "not recommended" by some health organizations? Why did the use of PSA testing fall drastically in the US in the last couple of years, while, at the same time, the tendency for diagnosis of higher risk diseases is noticed through large controlled studies, showing the efficacy of PSA testing in mortality reduction? Will PSA serve as a milestone for early detection and mass population screening in general? This review will deal with aspects of PSA screening and will bring the latest updates and dilemmas concerning this evolving topic. We will review the evolution of PSA testing and the different aspects of its application and effects on mortality reduction, overdiagnosis and overtreatment. Finally, we will bring the latest innovations in Pca screening and offer practical ways to deal with early detection and treatment of Pca in order to balance overdetection and overtreatment on the one hand and the need for early detection and treatment of aggressive Pca on the other.