Although prostate specific antigen (PSA) screening for prostate cancer has been a standard of care (SOC) for many years, its benefits have caused debate recently. The United States Preventive Services Task Force (USPSTF) changed its guidelines in 2018 advising men 55-69 years to make an informed choice and discuss with their doctor whether PSA screening is right for them, while recommending against screening for men over 70 years of age. This change in guidance came about after a review of published data of 1.9 million men on the use of PSA testing to screen for cancer based on the potential harms and benefits for PSA screening.
Limitations of PSA might include:
• Low sensitivity and specificity for prostate cancer
• PSA levels can be increased by benign prostatic hyperplasia (BPH) and prostatic inflammation or lower urinary tract infection
• When PSA results are in the “gray zone”, other factors such as age, family history, ethnicity and digital rectal examination (DRE) factor into the shared decision-making discussion regarding prostate biopsy
• PSA cannot distinguish high grade from low grade cancer and is not prostate cancer specific