PSA-based early detection of prostate cancer

Prostate-specific antigen (PSA)-based early detection of prostate cancer has resulted in a reduction of prostate cancer-specific mortality of 27 %; however, population-based PSA screening has been critisized for a relatively high rate of overdiagnosis and overtreatment. New results on the significance of an early PSA baseline value at the age of 40-45 years, clinical risk factors, molecular and new imaging procedures have the potential to individualize and to greatly improve screening for prostate cancer. This review article presents the currently available data and gives recommendations for the practical approach. A semiquantitative literature search was performed with special emphasis on studies from the last 2 years. Current data confirm the prognostic value of a baseline PSA value at the age of 45-50 years. This represents one of four possible risk-adapted screening approaches. This strategy is currently being tested in a prospective randomized trial in Germany with 50,000 men (PROBASE). The other modalities of risk-adapted screening have not yet been shown to be applicable in practice but together with clinical parameters, molecular profiles and modern magnetic resonance imaging (MRI), early detection programs will be improved in the future. Even now, a baseline PSA-based risk-adapted screening strategy can reduce the number needed to screen. With active surveillance and modern multiparameter MRI the number needed to treat has also already been decreased.