Clinicians screen for prostate specific antigen (PSA) with the goal of identifying localized disease before it becomes systemic and kills the patient. Only a prostate biopsy can confirm the suspicion of prostate cancer raised by an elevated PSA. When first proposed as a screening test in 1991, the cut point was set at 4 ng/mL.
1Unfortunately, controversy surrounding this practice has raged for the past three decades. Urologists often proceed with a prostate biopsy when values cross 3 ng/mL out of fear of missing clinically significant disease. The US Preventive Task Force advises against PSA testing at any threshold because a majority of men have negative biopsies or are found to have clinically insignificant disease.
- Catalona WJ
- Smith DS
- Ratliff TL
- et al.
Measurement of prostate-specific antigen in serum as a screening test for prostate cancer.
N Eng J Med. 1991; 324: 1156-1161
2Optimal practice lies somewhere in between.
- Moyer VA
- et al.
Screening for prostate cancer: US Preventive services task force recommendation statement.
Ann Intern Med. 2012; 157: 120-134
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- Measurement of prostate-specific antigen in serum as a screening test for prostate cancer.N Eng J Med. 1991; 324: 1156-1161
- Screening for prostate cancer: US Preventive services task force recommendation statement.Ann Intern Med. 2012; 157: 120-134
- Reconsidering prostate cancer mortality – The future of PSA screening.N Eng J Med. 2020; 382: 1557-1563
Accepted: May 5, 2021
Received: January 20, 2021
© 2021 Published by Elsevier Inc.