PSA in screening for prostate cancer: more good than harm or more harm than good?

The aim of screening for prostate cancer is to detect malignancy at an early and potentially treatable stage, thereby increasing the chance of cure. Although serum PSA has been used as a screening test for prostate cancer for over 20 years, the practice is controversial. As a screening test for prostate cancer, PSA lacks sensitivity and specificity for early disease. Furthermore, screening may lead to unnecessary biopsies, overdetection, and overtreatment. It is thus unclear whether the benefits of screening outweigh the harms. Although published guidelines differ in their recommendation for PSA screening, almost all state that prior to PSA testing, men should be informed of the risks and benefits of the process. Most guidelines also state that men with a life expectancy of less than 10 years should not be screened. New markers currently undergoing evaluation such as -2proPSA, Prostate Health Index, and PCA3 may complement PSA in the detection of early prostate cancer.