An inconvenient truth: at least three prostate-specific antigen-based screening cycles are needed to reduce subsequent prostate cancer incidence

The pros and cons of using prostate-specific antigen (PSA) for prostate cancer (PC) screening have been debated in terms of mortality reduction versus overdiagnosis and overtreatment as well as the overall balance of quality-of-life effects and cost-effectiveness. Because PSA is not a PC-specific biomarker, the use of PSA as a biomarker for PC has several limitations. In addition, PSA levels are influenced by several factors, including age, acute prostatitis, ejaculation, catheterization, and certain medications. Furthermore, there is no precise value indicative of a lack of PC risk, and PSA levels cannot distinguish between indolent and aggressive disease, particularly at PSA levels below 20 ng/mL. In addition, approximately 15% men with serum PSA levels below 4 ng/mL are at risk for PC (1).