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Treatment for PSA screen-detected prostate cancer: what are the options?

Nature Reviews Urology volume 6, pages 132–134 (2009)Cite this article

Over the past 25 years, prostate cancer in the UK has become a high-profile disease, receiving almost as much media attention as breast cancer. Management of prostate cancer once consisted of either masterly inactivity or surgical castration; however, with increasing surgical and radiotherapeutic options vying for primacy, the treatment of prostate cancer is rapidly changing, and a new consensus for management is required.

PSA screening has greatly affected the management of prostate cancer; PSA levels can be used as a trigger to investigate whether prostate cancer is present, which has resulted in earlier detection. PSA tests can also be helpful in predicting whether patients will later develop prostate cancer: in a study that assessed serum stored in bio-banks, elevated PSA levels 25 years before prostate cancer diagnosis were predictive of prostate-cancer-specific mortality.1 An increase in PSA level is a possible indicator of underlying prostate inflammation, which is now recognized as a risk factor for prostate cancer,2 and is also a possible indicator of inflammation-induced oncogenesis from “wounds that do not heal”.3 The value of PSA testing is, however, controversial: it has a high false-positive rate, and the more malignant the cancer, the less intense the cellular expression of PSA. Furthermore, PSA testing detects prostate cancer at least 10 years before clinical presentation,4 and its clinical benefit is uncertain.5 Prostate cancer mortality rates have declined in recent years, but the long lead-time bias of PSA testing, and the finding that countries without PSA screening have also reported declining rates in prostate-cancer-specific mortality,6 make it unlikely that the decline in mortality rates are solely due to the early diagnosis of prostate cancer. Variables that could also have reduced the mortality rates include a reduction in the incidence of sexually transmitted infections since the 1980s,7 and the reduced use of first-generation organochloride pesticides between 1960 and 1980.8 A review of publicly available data in the US and UK did, however, find that deaths were falling more rapidly in the US, where PSA screening is routine, than in the UK, where screening is not standard practice.9

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Author information

Authors and Affiliations

  1. RTD Oliver is a Professor Emeritus in Medical Oncology at the Institute of Cancer Department of Experimental Cancer Medicine, St Barts & The London School of Medicine, Queen Mary University of London, London, UK.,

    R Tim D Oliver

  2. DE Neal is a Professor of Surgery at the Department of Urology, University of Cambridge Medical School, Cambridge, UK.,

    David E Neal

Authors
  1. R Tim D Oliver
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  2. David E Neal
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Corresponding author

Correspondence to R Tim D Oliver.

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The authors declare no competing financial interests.

Supplementary information

Supplementary Table 1

Overview of randomized trials of hormone therapy and surgery for prostate cancer (DOC 58 kb)

Supplementary Table 2

Comparison of early results of new surgical approaches to radical prostatectomy.7 (DOC 58 kb)

Supplementary Table 3

Summary of phase II trials in patients with localized prostate cancer. (DOC 58 kb)

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Oliver, R., Neal, D. Treatment for PSA screen-detected prostate cancer: what are the options?. Nat Rev Urol 6, 132–134 (2009). https://doi.org/10.1038/ncpuro1297

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