While the Prostate Specific Antigen (PSA) blood test has been available since 1986 and FDA-approved for the early detection of prostate cancer since the early 1990s, 2012 marked a critical inflection point when the US Preventative Services Task Force (USPSTF) gave PSA a D-rating and generally discouraged its use. This D-rating was based on one randomized controlled trial (RCT) that showed no survival benefit to screening and another RCT that showed a survival benefit but at the cost of over-detection of non-life-threatening tumors. Despite the USPSTF, the PSA test remains widely used and many experts feel that the PSA test is still valuable when used in a more intelligent way. In using PSA more effectively, the American Urological Association (AUA) and the National Comprehensive Cancer Network (NCCN) suggest that all men have a baseline PSA test at age 40 to assess their future risk of prostate cancer. Using this baseline along with changes over time in the form of PSA Velocity (PSAV) or PSA Doubling Time (PSA-DT) can help doctors pick of prostate cancer in young men where finding cancers is more relevant. Further ways to use PSA smarter include age-adjusting PSA levels to increase detection of important cancers in young men while avoiding detection of non-life threatening cancers in older men. Taking into account other high risk features such as family history and race/ethnicity can fine tune early detection efforts. In addition to using total PSA, other PSA tools include the percent free PSA, complexed PSA, and the urine-based molecular marker, PCA-3 can further improve the accuracy of prostate cancer early detection efforts. Finally, if a prostate cancer is detected, better risk stratification can help doctors decide if a patient requires active treatment with surgery or radiation or active surveillance.
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