[PSA screening and molecular markers]

Area of Science:

• Urology
• Oncology
• Preventive Medicine

Background:

• Prostate cancer (PCA) is the most common cancer in men.
• Widespread prostate-specific antigen (PSA) screening may lead to overdiagnosis.
• Overdiagnosis contributes to increased PCA incidence rates.

Purpose of the Study:

• Review three major randomized trials of PSA-based screening.
• Evaluate the benefits and disadvantages of general PSA screening.
• Explore strategies to mitigate harms from overdetection and overtreatment while identifying clinically relevant tumors.

Main Methods:

• Literature search of the PubMed database.
• Focus on PSA-based screening, molecular serum markers, and risk-adapted PSA screening.

Main Results:

• The ERSPC study showed reduced relative and absolute mortality risk from PSA screening.
• PSA screening was linked to a lower risk of metastatic disease.
• Tests like PHI, 4Kscore, and risk-adapted screening improve PSA specificity, reducing unnecessary biopsies and overtreatment.
• Baseline PSA assessment in the 50s enables risk-adapted screening intervals, currently evaluated in the PROBASE trial.

Conclusions:

• Neither complete rejection nor universal adoption of PSA screening is ideal.
• Risk-adapted PSA screening, incorporating baseline PSA and serum markers, can minimize unnecessary interventions and associated morbidities without compromising sensitivity.