Screening: Actual trends on PSA marker. When, who, how?

Area of Science:

• Urology
• Oncology
• Preventive Medicine

Background:

• Prostate cancer (PCa) is a leading non-skin cancer in men globally, with higher incidence in African American men and those with a family history.
• US Preventive Services Task Force (USPSTF) recommendations have influenced PCa screening rates, with a shift from a Grade D to a shared-decision model for men aged 55-69.
• A notable increase in locally advanced and metastatic PCa rates occurred following the initial USPSTF recommendation against screening.

Purpose of the Study:

• To critically review current prostate cancer screening practices, focusing on PSA (prostate-specific antigen) screening limitations.
• To evaluate when physicians should initiate a shared-decision process for PSA screening.
• To explore advancements like mpMRI and biomarkers for improved PCa diagnosis and risk stratification.

Main Methods:

• A side-by-side evaluation of three key trials (ERSPC, CAP, PCLO) included in the USPSTF review.
• Analysis of screening intensity and contamination rates in trial control arms.
• Review of current literature on PSA screening, mpMRI, and emerging biomarkers.

Main Results:

• The ERSPC trial demonstrated earlier mortality curve divergence due to high-intensity screening and lower control arm contamination compared to CAP and PCLO trials.
• Despite controversy, PSA screening has proven efficacy in reducing PCa mortality.
• mpMRI shows promise in diagnosing PCa and identifying clinically significant tumors, aiding in risk stratification.

Conclusions:

• PSA screening remains a vital tool for reducing prostate cancer mortality, but careful patient selection is crucial.
• Shared-decision making, informed by PSA baseline levels and potentially mpMRI, can help differentiate high-risk patients and mitigate overdiagnosis/overtreatment.
• Ongoing research into biomarkers is essential for advancing our understanding and management of prostate cancer.