Using PSA to screen for prostate cancer. The Washington University experience

The evidence is mounting that PSA-based screening for prostate cancer is rational and effective at detecting a high proportion of cancer that is both clinically significant and curable by radical prostatectomy. However, more information is necessary to define the optimal ages at which screening should be performed and to determine the appropriate role of repetitive PSA measurement, PSA density, and PSA slope in serial screening. Formal demonstration of a significant screening-induced reduction of cancer-specific morbidity and mortality is necessary to unambiguously justify screening for prostate cancer. A randomized trial evaluating prostate cancer screening will soon be started under the auspices of the National Cancer Institute. Additionally, refinements in serum PSA testing that consider the variable binding of PSA derived from benign and malignant prostatic tissues to serum proteins may further enhance the performance of PSA testing in the screening setting. For these reasons, PSA-based screening for prostate cancer seems destined to remain an important strategy for minimizing the health consequences of this disease.