The prostate-specific antigen test

Abstract

Before the 1980s, prostate cancer (PC) was considered a deadly disease. The mortality-incidence ratio showed that 1 out of each 2 - 3 PC patients died of this disease. On the other hand, autopsy studies have shown that latent PC is common in middle-aged men. The prostate-specific antigen (PSA), a glycoprotein produced by the epithelial cells of the prostate gland, received FDA's approval in 1986 for monitoring treatment response, and in 1994 as a screening aid for the diagnosis of PC. After the publication of two randomized trials on PC screening using the PSA test, it is generally accepted that systematic PSA-based screening, as compared to a clinical situation with virtually no screening, can reduce suffering from metastatic disease and PC mortality. However, what is also shown is that PSA-based screening coincides with a considerable amount of unnecessary testing and overdiagnosis. Should we abandon the use of the PSA test for the diagnosis of PC, or should we encourage PSA testing and make it freely available for all men at any time? Both the answers should be "No." What we must do is use the test as wisely as is currently possible and inform men, who want to be tested, in a balanced way about harms and potential benefits.