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EDITORIAL COMMENT

      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.
      • Catalona WJ
      • Smith DS
      • Ratliff TL
      • et al.
      Measurement of prostate-specific antigen in serum as a screening test for prostate cancer.
      Unfortunately, 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.
      • Moyer VA
      • et al.
      Screening for prostate cancer: US Preventive services task force recommendation statement.
      Optimal practice lies somewhere in between.
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      References

        • 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
        • Moyer VA
        • et al.
        Screening for prostate cancer: US Preventive services task force recommendation statement.
        Ann Intern Med. 2012; 157: 120-134
        • Welch HG
        • Albertsen PC.
        Reconsidering prostate cancer mortality – The future of PSA screening.
        N Eng J Med. 2020; 382: 1557-1563