PSA and Prostate Cancer Screening

Prostate-specific antigen or PSA is a protein produced exclusively by the prostate and released into the bloodstream.

Regular PSA dosing should be considered in all men over 50 years of age or over 45 if there is a family history of prostate cancer or if it is a black man.

Psa elevation may be the result of conditions such as prostatitis, benign prostatic hypertrophy, or prostate cancer. However, a PSA value greater than 4ng/mL should always be considered an alarm signal and motivate evaluation by a Urologist.

Evaluation of PSA should not dispense with periodic performance of a physical evaluation with rectal touch. There are other complementary studies such as prostate ultrasonography or multiparametric magnetic resonance imaging of the prostate that should be considered on a case-by-case basis. The definitive diagnosis of a prostate cancer presupposes the performance of a prostate biopsy.

There are mixed opinions on the recommendation of universal screening of the general population. Screening for prostate cancer by dosing PSA enables early diagnosis of the disease, reducing the risk of death by the disease. The main disadvantages are the fact that 15-20% of cancer diagnoses can fail – causing a false sense of safety to the patient who has a PSA value within normal values – and the possible “over-diagnosis” of low-risk diseases that, in turn, would result in an “over-treatment” that also has adverse effects that impact on the patient’s quality of life.

Prostate cancer is a heterogeneous disease, classified according to risk criteria. A small percentage of patients with low-risk disease do not require immediate treatment and may enter an active surveillance programme. Thus, an “overdiagnosis” does not necessarily result in “overtreatment”. However, even in this context, the psychological impact underlying the diagnosis of an oncological disease should not be devalued.

In a range, PSA screening should be proposed to all men over 45/50 years of age with an average life expectancy of more than 10 years and should be supplemented with a rectal touch assessment. The approach of a high PSA value, particularly the decision to perform a prostatic psychopsychosia, should always be the responsibility of a Urologist.