According to a recent publication by the American Cancer Society, published in the Journal of the National Cancer Institute, following the 2012 USPSTF recommendations against routine PSA screening, while local disease decreased in age groups 50-74 and similarly in individuals 75 years and older, invasive forms of PCa (regional and distant) continue to increase in the US in men aged ≥50 years.
While a uniform recommendation against screening can reduce overdiagnosis and overtreatment of indolent, low-risk disease, such an approach also misses the diagnosis of high-risk disease, for which treatment is effective in decreasing mortality. A more nuanced risk-stratified approach is required to improve patient outcomes and reduce mortality due to PCa. Focus has shifted to discriminating high-grade prostate cancer (HGPCa) (GGgreater than or equal to sign2), and especially dominant pattern 4 disease (greater than or equal to signGG3), from low-grade PCa and benign tissue. This screening strategy has the potential to maintain the mortality reduction benefits of PSA screening while reducing harm from the over-detection and overtreatment of low-grade, indolent PCa.