Peter S Bunting1. 1. Gamma-Dynacare Medical Laboratories, 115 Midair Court, Brampton, Ontario, Canada L6T 5M3. buntingp@gamma-dynacare.com
Abstract
BACKGROUND: The evidence relating to the use of prostate-specific antigen (PSA) as a screening test is a highly controversial, as demonstrated by the lack of agreement among experts. There may be biases associated with various studies. ISSUES: The main controversy is the relatively high prevalence of prostate cancer (PC) found at autopsy compared with the relatively low death rate from the disease. The lack of modifiable risk factors has led to early detection as a strategy to reduce mortality, as there is evidence for a significant burden of disease. Important issues are the accuracy of current screening tests, some attempts to improve on them, and whether there are good prognostic markers. The consequences of PSA testing (usually further testing including biopsy) and outcomes of treatment are presented in terms of mortality and morbidity; quality of life (QOL) must also be considered. Also important are the benefits from, and the difficulties associated with the "informed choice" approach to PSA screening. CONCLUSION: There is evidence to suggest that biases can have a significant impact on the utility of PSA as a screening test for PC.
BACKGROUND: The evidence relating to the use of prostate-specific antigen (PSA) as a screening test is a highly controversial, as demonstrated by the lack of agreement among experts. There may be biases associated with various studies. ISSUES: The main controversy is the relatively high prevalence of prostate cancer (PC) found at autopsy compared with the relatively low death rate from the disease. The lack of modifiable risk factors has led to early detection as a strategy to reduce mortality, as there is evidence for a significant burden of disease. Important issues are the accuracy of current screening tests, some attempts to improve on them, and whether there are good prognostic markers. The consequences of PSA testing (usually further testing including biopsy) and outcomes of treatment are presented in terms of mortality and morbidity; quality of life (QOL) must also be considered. Also important are the benefits from, and the difficulties associated with the "informed choice" approach to PSA screening. CONCLUSION: There is evidence to suggest that biases can have a significant impact on the utility of PSA as a screening test for PC.
Authors: Vickie L Shavers; Martin L Brown; Arnold L Potosky; Carrie N Klabunde; W W Davis; Judd W Moul; Angela Fahey Journal: J Gen Intern Med Date: 2004-02 Impact factor: 5.128
Authors: Andrew G Matthew; Shabbir M H Alibhai; Tal Davidson; Kristen L Currie; Haiyan Jiang; Murray Krahn; Neil E Fleshner; Robin Kalnin; Alyssa S Louis; B Joyce Davison; John Trachtenberg Journal: Qual Life Res Date: 2014-03-09 Impact factor: 4.147
Authors: Selin Merdan; Scott A Tomlins; Christine L Barnett; Todd M Morgan; James E Montie; John T Wei; Brian T Denton Journal: Cancer Date: 2015-08-17 Impact factor: 6.860
Authors: Irene Casanova-Salas; José Rubio-Briones; Antonio Fernández-Serra; Jose Antonio López-Guerrero Journal: Clin Transl Oncol Date: 2012-07-24 Impact factor: 3.405