PSA-based early detection of prostate cancer

Prevention of prostate cancer up to now is not possible, advanced stages of prostate cancer are not curable. About 13 000 men a year die of prostate cancer in Germany. PSA-based screening has been shown to be effective in detecting prostate cancer at an early, potentially curable stage; however, this tumor marker is limited by appreciable false-positive and false-negative results. Several PSA-related indexes may improve the power of PSA in early detection: As PSA density, age-adjusted PSA, and percent free PSA. These indexes can improve positive predictive value of PSA-testing, but are not able to differentiate carcinoma from benign hyperplasia on an individual basis. Men presenting for early detection have to be informed about possible overtreatment before undergoing biopsy to further investigate increased PSA above 4.0 ng/ml or suspect findings in digital rectal examination.