[New recommendations for prostate cancer screening with PSA]

Area of Science:

• Oncology
• Urology
• Public Health

Background:

• Prostate cancer is a leading cause of cancer diagnosis and mortality in men globally.
• The long latency period of prostate tumors complicates early diagnosis and treatment decisions.
• Screening practices for prostate cancer have been historically controversial, particularly regarding the use of PSA testing.

Purpose of the Study:

• To review the evolution of prostate cancer screening recommendations.
• To analyze the impact of guideline changes on prostate cancer incidence and mortality.
• To highlight the shift in European guidelines towards advocating for PSA screening.

Main Methods:

• Review of historical and current clinical guidelines from major European and American societies.
• Analysis of trends in prostate cancer incidence, stage at diagnosis, and mortality following guideline changes.
• Examination of the role of prostate-specific antigen (PSA) testing in prostate cancer screening.

Main Results:

• The United States Preventive Services Task Force recommended against PSA screening in 2012, leading to an increase in metastatic prostate cancer diagnoses and mortality.
• In response to these adverse outcomes, the European Association of Urology revised its guidelines in 2018 to support PSA-based screening for prostate cancer.
• Subsequent guideline updates in 2019 maintained the recommendations in favor of screening.

Conclusions:

• The controversy surrounding PSA screening for prostate cancer has had significant public health consequences.
• Shifting recommendations away from screening contributed to a rise in advanced prostate cancer.
• Current European guidelines support PSA screening, reflecting a re-evaluation of its benefits in managing prostate cancer.