Population Screening for Prostate Cancer and Early Detection

Introduction

Prostate cancer (PCa) is the most commonly diagnosed new solid cancer and the second most common cause of cancer-related deaths in men in the United States. The American Cancer Society (ACS) estimated that approximately 241,740 new cases and 28,170 PCa-related deaths would occur in the United States in 2014. PCa is now the second-leading cause of cancer death in men, exceeded only by lung cancer. It accounts for 29% of all male cancers and 9% of male cancer-related deaths.

The prostate-specific antigen (PSA) concentration in the blood is a test approved by the US Food and Drug Administration as an aid to the early detection of PCa. Screening with PSA has been widely used to detect PCa for decades in the United States and many industrialized nations but it continues to be controversial. Until a few years ago, the ACS and the American Urological Association (AUA) recommended PCa screening for men at average risk who are 50 years or older and have a life expectancy of at least 10 years, after the patient and physician discuss the risks and benefits of screening and intervention. Screening was recommended for higher-risk groups, such as African-American (AA) men, beginning at age 40 years. There is much debate over the sensitivity of PSA tests and the ultimate effect on morbidity and mortality of detecting PCa at early, potentially clinically insignificant stages, so called “overdetection.”

In May 2012, the US Preventive Services Task Force (USPSTF) issued a new guideline against PSA testing and gave the test a “D-rating” indicating that it resulted in more harm than good. Since this time, the debate has been heated and the AUA and other organizations have now come together to oppose population-based screening. In this chapter, I will further explore this controversy and discuss the rationale and basis for using PSA in the early detection of PCa.