LAUSR

The widespread use of Prostate-specific antigen (PSA)-based early detection (opportunistic PSAbased screening) of prostate cancer (PCa) since the beginning of this century has led to a marked reduction in cancer-specific mortality (CSM) and a simultaneous increase in incidence (1). However, screening also gave rise to an increasing detection of low-risk PCa without immediate need for treatment, resulting in controversial and critical discussions on the usefulness of opportunistic PSA-based screening which continue to the present day (1, 2). The US Preventive Task Force issued a recommendation against PSA screening in 2012, which was revised in 2017 as a consequence of the observed stage shift towards more advanced and metastatic stages resulting from the initial recommendation, in addition to study data supporting the evidence that PSA-based screening results in a significant reduction of CSM (1, 3). Accordingly, it is now indisputable that PSA screening results in a decrease in CSM (by 35% after 18 years of follow-up in the Göteborg arm of the European Randomized study of Screening for Prostate Cancer) and a lower incidence rate of metastatic disease stages, but it is also associated with a substantial risk of overdiagnosis (1, 4). Falsepositive findings and resulting eventual complications of prostate biopsy as well as subsequent overtreatment represent potential harm to patients invited for PSA-based screening (5).