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Prostate cancer screening-when to start and how to screen?
Kimia Kohestani1,2, Marina Chilov3, Sigrid V Carlsson1,4
1Institute of Clinical Sciences, Department of Urology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
Translational Andrology and Urology
|March 30, 2018
Summary
Prostate-specific antigen (PSA) screening lowers prostate cancer deaths but risks overdiagnosis. Shared decision-making between doctors and patients is vital for informed prostate cancer screening choices.
Area of Science:
- Urology
- Oncology
- Preventive Medicine
Background:
- Prostate-specific antigen (PSA) screening significantly reduces prostate cancer (PCa) mortality.
- However, PSA screening can lead to overdiagnosis and overtreatment, causing patient harm.
- Informed decision-making is essential due to the lack of consensus on optimal screening ages and protocols.
Purpose of the Study:
- To review current recommendations and evidence regarding prostate-specific antigen (PSA) screening for prostate cancer (PCa).
- To highlight the importance of shared decision-making in PSA screening protocols.
- To discuss strategies for reducing overdiagnosis and overtreatment associated with PSA screening.
Main Methods:
- Review of current clinical guidelines and literature on PSA screening for prostate cancer.
- Analysis of risk factors influencing screening decisions, including age, family history, and ethnicity.
- Evaluation of emerging diagnostic tools and risk stratification methods.
Main Results:
- Total PSA is a strong predictor of life-threatening PCa.
- Screening initiation age recommendations vary, with some suggesting as early as 45 for high-risk groups.
- Risk-stratified re-screening intervals and advanced diagnostics like MRI show promise in optimizing screening.
Conclusions:
- Shared decision-making is crucial for balancing the benefits and harms of PSA screening.
- Personalized screening strategies, considering individual risk factors and patient preferences, are recommended.
- Ongoing research and advanced diagnostic tools aim to improve the accuracy and reduce the harms of prostate cancer screening.
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