The use of PSA, biomarkers, risk calculators and mpMRI in the early detection of prostate cancer.

Henk Benjamin Luiting, Monique J Roobol

Abstract


Prostate cancer (PCa) is the most common cause of cancer in men in the developed world and the fifth leading cause of cancer death among men. In 1991 the use of prostate-specific antigen (PSA) level in serum was described to detect prostate cancer at an early stage, where curative treatment is still possible. To answer the question whether PSA-based screening could reduce PCa-specific mortality, two large randomized controlled trials were set up in 1993 namely; the Prostate, Lung, Colorectal and Ovary (PLCO) Cancer Screening Trial and the European Randomized Study of Screening for Prostate Cancer (ERSPC). After years of research followed by years of debate, the general consensus is that PSA-based screening can reduce PCa-specific mortality. Unfortunately, purely PSA-based screening results in harms like unnecessary biopsies, overdiagnosis of low-risk prostate cancer and subsequent overtreatment. In a purely PSA-based screening protocol, harms tend to outweigh the benefits. Therefore, further refinement of the screening algorithm is indicated. Risk calculators, contemporary biomarkers and imaging techniques like mpMRI can be used to  reduce the harms of PSA-based screening by improving the specificity of the PSA tests. In current practice, PSA tests, in general, are used on patient request. This so called opportunistic screening is mostly applied in elderly men who benefit least from PCa screening. Hence, further development and implementation of risk calculators, contemporary biomarkers and mpMRI is needed and will undoubtedly lead to a more favorable harm-benefit trade-off for prostate cancer screening. Pilot studies for the implementation of organized PCa screening programs should be started to determine the harm-benefit trade-off of these new modalities and to determine cost-effectiveness. A well-organized contemporary screening program is preferred above the current ineffective opportunistic screening practices.

Keywords


Prostate cancer, urology, screening, PSA

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References


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DOI: http://dx.doi.org/10.18103/imr.v5i1.780

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