LAUSR

Since May, when the United States Preventive Services Task Force (USPSTF) published its final updated recommendation regarding the use of prostate-specific antigen (PSA) to screen for prostate cancer [1], the longstanding PSA debate has been reinvigorated. Some argue that PSA screening sufficiently reduces the burden of death from prostate cancer to warrant widespread implementation. Others, however, believe that the downsides of overdiagnosis and overtreatment outweigh the benefits. For men aged 55– 69 yr, the USPSTF did not take sides; it recommended that the decision on whether or not to screen should be an individual one [1]. Rather than contribute another editorial deliberating the merits of PSA screening as it currently exists, we choose to ask an alternative question: how can PSA screening be improved such that the USPSTF would not have to hedge? In this issue of European Urology, Preston and colleagues [2] contribute data towards one possible solution: personalized PSA screening. They look at the use of a single PSA measurement in midlife to predict the risk of aggressive prostate cancer in black men (a population that is disproportionately affected by the disease). The authors suggest that such measurements can be used for risk stratification and in turn for the development of personalized screening strategies. Their results support this possibility; they find that a single PSA measurement in midlife is strongly associated with diagnosis of both total and aggressive prostate cancer. The sum of the evidence, including previous literature dealing with both black and white men, indicates that individuals with especially low PSA levels in midlife do