Rigi10™ Malleable Penile Prosthesis
Also Known As
PSA screening, prostate cancer screening, prostate cancer early detection, PSA testing, prostate-specific antigen testing, prostate cancer detection
Definition
Prostate screening refers to the process of testing asymptomatic men for prostate cancer or abnormalities that may lead to prostate cancer, with the goal of finding cancers that may be at high risk for spreading if not treated, and finding them early before they spread.1 The primary screening test is the prostate-specific antigen (PSA) blood test, often accompanied by a digital rectal examination (DRE).2 Prostate-specific antigen (PSA) is a glycoprotein enzyme secreted by the prostatic secretory epithelium and seminal vesicles and is the most abundant protein in seminal plasma.3 Elevated PSA levels have long been associated with prostatic malignancy and are the key initial element in screening, although high PSA titers are not specific to prostate cancer.4 Screening decisions should be individualized through shared decision-making between the patient and healthcare provider, weighing the potential benefits, risks, and uncertainties of screening, diagnosis, and treatment.5
Clinical Context
Prostate screening is clinically indicated for men based on age, risk factors, and individual preferences following shared decision-making with healthcare providers.1 According to the US Preventive Services Task Force (USPSTF), men aged 55 to 69 years should make individual decisions about being screened for prostate cancer with a PSA test after discussing the potential benefits and harms with their doctor.2 The USPSTF recommends against routine screening for men aged 70 and older.2
The American Cancer Society recommends that men have a chance to make an informed decision with their healthcare provider about whether to be screened for prostate cancer at different ages based on risk factors: age 50 for men at average risk, age 45 for men at high risk (including African American men and those with a first-degree relative diagnosed with prostate cancer before age 65), and age 40 for men at even higher risk (those with more than one first-degree relative who had prostate cancer at an early age).3
The American Urological Association (AUA) and Society of Urologic Oncology (SUO) recommend that clinicians engage in shared decision-making with people for whom prostate cancer screening would be appropriate and proceed based on a person’s values and preferences.4 They recommend using PSA as the first screening test, with regular screening every 2 to 4 years for people aged 50 to 69 years.4 For those at increased risk (Black ancestry, germline mutations, strong family history), screening should begin at age 40 to 45 years.4
Patient selection criteria include consideration of life expectancy (at least 10 years), risk factors (age, race/ethnicity, family history), and the patient’s values regarding the potential benefits and harms of screening.5 The screening process typically involves PSA testing, potentially followed by digital rectal examination (DRE), and if indicated, additional biomarker tests, imaging (such as MRI), and prostate biopsy.4
Expected outcomes of screening include potential reduction in prostate cancer mortality and metastatic disease through early detection, but also possible overdiagnosis and overtreatment of cancers that would never have caused symptoms or death.5 The potential harms of screening include false positive results leading to unnecessary procedures, complications from diagnostic procedures (such as infection from biopsy), and side effects from treatment (including urinary incontinence, erectile dysfunction, and bowel problems).5