Skip to main content

Advertisement

Log in

Prostate-specific antigen and detection of prostate cancer: What have we learned and what should we recommend for screening?

  • Published:
Current Treatment Options in Oncology Aims and scope Submit manuscript

Opinion statement

Prostate-specific antigen (PSA) has become one of the most commonly used cancer clinical tests, and routine PSA-based screening has led to a dramatic increase in prostate cancer detection. A significant downward stage migration has resulted, and a decrease in prostate cancer mortality has also been observed. However, PSA screening remains controversial because there is no definitive proof that it decreases prostate cancer death rates, and there is concern that it may detect a significant number of clinically insignificant cancers. Screening age and interval have been recently questioned, and the best threshold to recommend biopsy has been complicated by new data showing that prostate cancer exists at all PSA levels, even those thought to be “normal” in the past. It is hoped that ongoing prospective screening trials will determine the value of PSA screening. However, until these results are available the controversy will continue, and men will continue to be screened.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References and Recommended Reading

  1. Hernandez J, Thompson IM: Prostate-specific antigen: review of the validation of the most commonly used cancer biomarker. Cancer 2004, 101:894–904.

    Article  PubMed  CAS  Google Scholar 

  2. Catalona WJ, Smith DS, Ratliff TL, et al.: Measurement of prostate-specific antigen in serum as a screening test for prostate cancer. N Engl J Med 1991, 324:1156–1161.

    Article  PubMed  CAS  Google Scholar 

  3. Catalona WJ, Smith DS, Ratliff TL, et al.: Detection of organ-confined prostate cancer is increased through prostate-specific antigen-based screening. JAMA 1993, 270:948–954.

    Article  PubMed  CAS  Google Scholar 

  4. Ross LE, Coates RJ, Breen N, et al.: Prostate-specific antigen test use reported in the 2000 National Health Interview Survey. Prev Med 2004, 38:732–744.

    Article  PubMed  Google Scholar 

  5. Gann PH, Hennekens CH, Stampfer MJ: A prospective evaluation of plasma prostate-specific antigen for detection of prostate cancer. JAMA 1995, 273:289–294.

    Article  PubMed  CAS  Google Scholar 

  6. Punglia RS, D'Amico AV, Catalona WJ, et al.: Effect of verification bias on screening for prostate cancer by measurement of prostate-specific antigen. N Engl J Med 2003, 349:335–342.

    Article  PubMed  Google Scholar 

  7. Stamey TA, Johnstone IM, McNeal JE, et al.: Preoperative serum prostate specific antigen levels between 2 and 22 ng/ml correlate poorly with post-radical prostatectomy cancer morphology; prostate specific antigen cure rates appear constant between 2 and 9 ng/ml. J Urol 2002, 167:103–111.

    Article  PubMed  CAS  Google Scholar 

  8. Oesterling JE, Jacobsen SJ, Chute CG, et al.: Serum prostate specific antigen in a community-based population of healthy men: establishment of age-specific reference ranges. JAMA 1993, 270:860–864.

    Article  PubMed  CAS  Google Scholar 

  9. Catalona WJ, Hudson MA, Scardino PT, et al.: Selection of optimal prostate specific antigen cutoffs for early detection of prostate cancer: receiver operating characteristic curves. J Urol 1994, 152:2037–2042.

    PubMed  CAS  Google Scholar 

  10. Benson MC, Whang IS, Olsson CA, et al.: The use of prostate specific antigen density to enhance the predictive value of intermediate levels of serum prostate specific antigen. J Urol 1992, 147:817–821.

    PubMed  CAS  Google Scholar 

  11. Catalona WJ, Richie JP, deKernion JB, et al.: Comparison of prostate specific antigen concentration versus prostate specific antigen density in the early detection of prostate cancer: receiver operating characteristic curves. J Urol 1994, 152:2031–2036.

    PubMed  CAS  Google Scholar 

  12. Carter HB, Pearson JD, Metter EJ, et al.: Longitudinal evaluation of prostate-specific antigen levels in men with and without prostate disease. JAMA 1992, 267:2215–2220.

    Article  PubMed  CAS  Google Scholar 

  13. Partin AW, Brawer MK, Bartsch G, et al.: Complexed prostate specific antigen improves specificity for prostate cancer detection; results of a prospective multicenter clinical trial. J Urol 2003, 170:1787–1791.

    Article  PubMed  Google Scholar 

  14. Catalona WJ, Bartsch G, Rittenhouse HG, et al.: Serum pro-prostate specific antigen improves cancer detection compared to free and complexed prostate specific antigen in men with prostate specific antigen 2 to 4 ng/ml. J Urol 2003, 170:2181–2185.

    Article  PubMed  CAS  Google Scholar 

  15. Liu S, Lee IM, Linson P, et al.: A prospective study of physical activity and risk of prostate cancer in US physicians. Int J Epidemiol 2000, 29:29–35.

    Article  PubMed  CAS  Google Scholar 

  16. Draisma G, Boer R, Otto SJ, et al.: Lead times and overdetection due to prostate-specific antigen screening: estimates from the European Randomized Study of Screening for Prostate Cancer. J Natl Cancer Inst 2003, 95:868–878. Using results from the ERSPC screening trial, simulation models were developed to predict lead times and overdetection due to PSA screening.

    Article  PubMed  Google Scholar 

  17. Tarone R, Chu K, Brawley O: Implications of stagespecific survival rates in assessing recent declines in prostate cancer mortality rates. Epidemiology 2000, 11:167–170.

    Article  PubMed  CAS  Google Scholar 

  18. Bartsch G, Horninger W, Klocker H, et al.: Prostate cancer mortality after introduction of prostatespecific antigen mass screening in the federal state of Tyrol, Austria. Urology 2001, 58:417–424.

    Article  PubMed  CAS  Google Scholar 

  19. Labrie F, Candas B, Dupont A, et al.: Screening decreases prostate cancer death: first analysis of the 1988 Quebec prospective randomized controlled trial. Prostate 1999, 38:83–91.

    Article  PubMed  CAS  Google Scholar 

  20. Andriole GL, Levin DL, Crawford D, et al.: Prostate cancer screening in the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial: findings from the initial screening round of a randomized trial. J Natl Cancer Inst 2005, 97:433–438.

    Article  PubMed  Google Scholar 

  21. de Koning HJ, Liem MK, Baan CA, et al.: Prostate cancer mortality reduction by screening: power and time frame with complete enrollment in the European Randomized Screening for Prostate Cancer (ERSPC) trial. Int J Cancer 2002, 98:268–273.

    Article  CAS  Google Scholar 

  22. McGregor M, Hanley JA, Boivin JF, et al.: Screening for prostate cancer: estimating the magnitude of overdetection. CMAJ 1998, 159:1368–1372.

    PubMed  CAS  Google Scholar 

  23. Zappa M, Ciatto S, Bonardi R, et al.: Overdiagnosis of prostate carcinoma by screening: an estimate based on the results of the Florence Screening Pilot Study. Ann Oncol 1998, 9:1297–1300.

    Article  PubMed  CAS  Google Scholar 

  24. Etzioni R, Penson DF, Legler JM, et al.: Overdiagnosis due to prostate-specific antigen screening: lessons from U.S. prostate cancer incidence trends. J Natl Cancer Inst 2002, 94:981–990. A competing risk model was used to estimate prostate cancer overdiagnosis from PSA testing by comparison of modelpredicted incidence to observed incidence derived from SEER registry data.

    PubMed  Google Scholar 

  25. Gann PH: Interpreting recent trends in prostate cancer incidence and mortality. Epidemiology 1997, 8:117–120.

    PubMed  CAS  Google Scholar 

  26. Etzioni R, Cha R, Feuer EJ, et al.: Asymptomatic incidence and duration of prostate cancer. Am J Epidemiol 1998, 148:775–785.

    PubMed  CAS  Google Scholar 

  27. Ohori M, Wheeler TM, Dunn JK, et al.: The pathological features and prognosis of prostate cancer detectable with current diagnostic tests. J Urol 1994, 152:1714–1720.

    PubMed  CAS  Google Scholar 

  28. Stamey TA, Freiha FS, McNeal JE, et al.: Localized prostate cancer. Relationship of tumor volume to clinical significance for treatment of prostate cancer. Cancer 1993, 71:933–938.

    Article  PubMed  CAS  Google Scholar 

  29. Epstein JI, Carmichael M, Partin AW, et al.: Is tumor volume an independent predictor of progression following radical prostatectomy? A multivariate analysis of 185 clinical stage B adenocarcinomas of the prostate with 5 years of followup. J Urol 1993, 149:1478–1481.

    PubMed  CAS  Google Scholar 

  30. Loeb S, Gonzalez CM, Roehl KA, et al.: Pathological characteristics of prostate cancer detected through prostate specific antigen based screening. J Urol 2006, 175:902–906. Examined the pathologic characteristics of PSA-detected cancers by analysis of radical prostatectomy specimens from men whose cancer was detected from a large communitybased screening trial.

    Article  PubMed  Google Scholar 

  31. Wilson SS, Crawford ED: Screening for prostate cancer: current recommendations. Urol Clin N Am 2004, 31:219–226.

    Article  Google Scholar 

  32. Thompson IM, Pauler DK, Goodman PJ, et al.: Prevalence of prostate cancer among men with a prostate-specific antigen level < 4.0 ng per milliliter. N Engl J Med 2004, 350:2239–2246. The first trial to define the prevalence of prostate cancer at “normal” PSA levels.

    Article  PubMed  CAS  Google Scholar 

  33. Thompson IM, Ankerst DP, Chi C, et al.: Operating characteristics of prostate-specific antigen in men with an initial PSA level of 3.0 ng/ml or lower. JAMA 2005, 294:66–70.

    Article  PubMed  CAS  Google Scholar 

  34. Smith RA, Cokkinides V, Eyre HJ, et al.: American Cancer Society guidelines for the early detection of cancer. CA Cancer J Clin 2006, 56:11–25.

    Article  PubMed  Google Scholar 

  35. Prostate-specific antigen (PSA) best practice policy. American Urological Association (AUA). Oncology 2000, 14:267–272.

    Google Scholar 

  36. National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology. http//www.nccn.org/professionals/physician_gls/f_guidelines. Accessed March 15, 2006.

  37. Zoorob R, Anderson R, Cefalu C, et al.: Cancer screening guidelines. Am Fam Physician 2001, 63:1101–1112.

    PubMed  CAS  Google Scholar 

  38. Harris R, Lohr KN: Screening for prostate cancer: an update of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med 2002, 137:917–929.

    PubMed  Google Scholar 

  39. Boyle P: Screening for prostate cancer: have you had your cholesterol measured. BJU Int 2003, 92:191–199.

    Article  PubMed  CAS  Google Scholar 

  40. Ross KS, Carter HB, Pearson JD, et al.: Comparative efficiency of prostate-specific antigen screening strategies for prostate cancer detection. JAMA 2000, 284:1399–1405.

    Article  PubMed  CAS  Google Scholar 

  41. Crawford ED, Pinsky PF, Chia D, et al.: Prostate specific antigen changes as related to the initial prostate specific antigen: data from the Prostate, Lung, Colorectal and Ovarian Cancer screening trial. J Urol 2006, 175:1286–1290. Using data from the PLCO screening trial, this study assessed the probability of developing an abnormal PSA elevation over a screening interval and suggested that screening could be performed less often than annually when the initial screening PSA is low.

    Article  PubMed  CAS  Google Scholar 

  42. Catalona WJ, Loeb S, Han M: Viewpoint: expanding prostate cancer screening. Ann Intern Med 2006, 144:441–443.

    PubMed  Google Scholar 

  43. Presti JC, O'Dowd GJ, Miller MC, et al.: Extended peripheral zone biopsy schemes increase cancer detection rates and minimize variance in prostate specific antigen and age related cancer rates: results of a community multi-practice study. J Urol 2003, 169:125–129.

    Article  PubMed  Google Scholar 

  44. Alibhai SM, Naglie G, Nam R, et al.: Do older men benefit from curative therapy for localized prostate cancer. J Clin Oncol 2003, 21:3318–3327.

    Article  PubMed  Google Scholar 

  45. Welch HG, Albertson PC, Nease RF, et al.: Estimating treatment benefits for the elderly: the effect of competing risks. Ann Intern Med 1996, 124:577–584.

    PubMed  CAS  Google Scholar 

  46. Etzioni RD, Howlander N, Shaw PA, et al.: Long-term effects of finasteride on prostate-specific antigen levels: results from the Prostate Cancer Prevention Trial. J Urol 2005, 174:877–881.

    Article  PubMed  CAS  Google Scholar 

  47. Anternor JA, Roehl KA, Eggener SE, et al.: Preoperative PSA and progression-free survival after radical prostatectomy for stage T1c disease. Urology 2005, 66:156–160.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Amling, C.L. Prostate-specific antigen and detection of prostate cancer: What have we learned and what should we recommend for screening?. Curr. Treat. Options in Oncol. 7, 337–345 (2006). https://doi.org/10.1007/s11864-006-0001-1

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11864-006-0001-1

Keywords

Navigation