Prostate cancer screening
The evidence remains insufficient to determine whether screening with PSA or DRE reduces mortality from prostate cancer.
[1] A 2013 Cochrane review concluded PSA screening results in "no statistically significant difference in prostate cancer-specific mortality...".
European studies included in this review were of low bias and one reported "a significant reduction in prostate cancer-specific mortality."
[12][13] Prostate-specific antigen (PSA) is secreted by the epithelial cells of the prostate gland and can be detected in a sample of blood.
[22] During a digital rectal examination (DRE), a healthcare provider slides a gloved finger into the rectum and presses on the prostate, to check its size and to detect any lumps on the accessible side.
[2] A 2018 review recommended against primary care screening for prostate cancer with DRE due to the lack of evidence of the effectiveness of the practice.
[27] A study by Krilaviciute et al. (2023)[28] examined the effectiveness of the DRE as a standalone screening test for prostate cancer in >46,000 young men in Germany (age 45).
[30] People who have localized cancer and perineural invasion may benefit more from immediate treatment rather than adopting a watchful waiting approach.
[dubious – discuss][citation needed] MRI imaging can be used for patients who have had a previous negative biopsy but whose PSA continues to increase.
[39] In the theranostic paradigm, 68Ga-PSMA PET/CT imaging is critical for detecting prostate-specific membrane antigen-avid disease which may then respond to targeted 177Lu-PSMA or 225Ac-PSMA therapies.
[40] PSMA PET/CT may be potentially helpful for locating the cancer when combined with multiparametric MRI (mpMRI) for primary prostate care.
[42] Several biomarkers (blood, urine, and tissue-based tests) for screening, diagnosing, and determining the prognosis of prostate cancer are supported by evidence and used widely.
[43][44] In 2020, researchers at the Korea Institute of Science and Technology developed a urinary multi-marker sensor with the ability to measure trace amounts of biomarkers from naturally voided urine.
[48] The correlation of clinical state with the sensing signals from urinary multi markers was analyzed by two machine learning algorithms: random forest and neural network.
[56] Thus, PSA screening is advocated by some as a means of detecting high-risk, potentially lethal prostate cancer, with the understanding that lower-risk disease, if discovered, often does not need treatment and may be amenable to active surveillance.
[59] Private medical institutes, such as the Mayo Clinic, likewise acknowledge that "organizations vary in their recommendations about who should – and who shouldn't – get a PSA screening test."
They conclude: "Ultimately, whether you should have a PSA test is something you'll have to decide after discussing it with your doctor, considering your risk factors, and weighing your personal preferences.
"[60] A 2009 study in Europe resulted in only a small decline in death rates and concluded that 48 men would need to be treated to save one life.
[64] A study published in the New England Journal of Medicine in 2009 found that over a 7 to 10-year period, "screening did not reduce the death rate in men 55 and over.
"[59] A further study, the NHS Comparison Arm for ProtecT (CAP), as part of the Prostate testing for cancer and Treatment (ProtecT) study, randomized GP practices with 460,000 men aged 50–69 at centers in 9 cities in Britain from 2001–2005 to usual care or prostate cancer screening with PSA (biopsy if PSA ≥ 3).
