LAUSR

Prostate cancer (PCa) is the third leading cause of cancer death in Canadian men. Before the introduction of prostate-specific antigen (PSA) testing in the 1980s, most prostate cancers were often diagnosed late, by means of digital rectal examination. Since then, PCa mortality has declined by at least 20% in Canada. However, massive screening has led to the detection and treatment of indolent cancers that would have otherwise gone unnoticed. This overtreatment is associated with morbidity, psychological distress, and great costs and is why PSA screening remains one of the most controversial topics in modern medicine. The purpose of this review is to explain what PSA is and what can influence its serum level, describe its role as a screening tool, and, finally, discuss the recent major screening trials. Prostate cancer (PCa) is the third leading cause of cancer death in Canadian men. The lifetime risk for a man to have a diagnosis of PCa is 13.6%, and his lifetime risk of death from PCa is 3.7%. Before the advent of prostate specific antigen (PSA) screening, PCa was usually diagnosed by means of digital rectal examination (DRE), often in men presenting with symptoms. At that time, up to 35% of patients were initially diagnosed with locally advanced or metastatic disease. Since the 1980s, with the introduction of the PSA testing concomitantly with the Trans-Rectal Ultra-Sound (TRUS)-guided biopsy gun, an important stage migration at diagnosis has been observed and most cancers diagnosed today are confined to the organ. Mortality has also been declining. In Canada, mortality per 100,000 men per year has declined by at least 20% since the introduction of PSA testing, despite a significant increase in men’s longevity. Some have attributed this to earlier detection and better treatment. PSA received FDA approval for the monitoring of treatment response and recurrence in 1986 and was approved for PCa screening of asymptomatic men in conjunction with DRE in 1994. Although widely used in daily practice, there remains a major controversy regarding the appropriate use of PSA testing for early detection of PCa.