Use of prostatic specific antigen in primary care (PSA): Beyond the Abstract

The conclusions and the use that have surrounded the prostate-specific antigen (PSA) since its incorporation into the usual clinical practice during the 1990s have varied over the years. Like any screening tool, it should serve to detect the largest number of cases (by excess), minimizing the number of false negatives, in addition to achieving an increase in the survival of an oncological disease such as prostate cancer, considered the more prevalent solid neoplasia in Europe (1).

However, the results are controversial, and in the 2 large prospective studies in Europe and the United States, they have not concluded a firm efficacy of PSA screening (2, 3). This controversy may be the reason that in studies such as ours and others published, it shows a limited use of this marker or some mistrust in its effectiveness for the early diagnosis of prostate cancer by some medical professionals (4).

On the other hand, there are studies that demonstrate a high economic cost derived from the use of this marker. This fact, along with other factors such as the anxiety that patients may experience when entering a screening program or the sometimes indiscriminate use of PSA, reflect the need for proper training of health professionals in this context. Any physician who uses this marker should be aware of the uses and limitations of this screening tool, making proper use of it (5). It is convenient to know the use we make of the PSA, in order to know how we can improve it.

There are different tools that could optimize the use of this marker in the screening of prostate cancer, such as information campaigns from urologists to primary care physicians, or information campaigns on patients, so that they can know what PSA and screening for prostate cancer are, and when they should visit their doctor. In the end, this marker has been a resource used during the last decades to diagnose this neoplasm early, and should not be abandoned or questioned its usefulness. The data of our study, showing a limited use of the same by primary care physicians, or the belief by these professionals that it is not a useful tool, reflects a need for training and knowledge of the PSA, which both primary care physicians and urologists are responsible. The great beneficiary of the correct use of PSA and the adequate screening of prostate cancer will be the patient, and for this purpose we must collaborate and do our bit.

Written by: Jorge Panach-Navarrete, MD

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References: 
1. Oliver SE, May MT, Gunnell D. International trends in prostate-cancer mortality in the "PSA ERA". Int J Cancer. 2001;92:893-8.

2. Andriole GL, Crawford ED, Grubb RL, 3rd, Buys SS, Chia D, Church TR, et al. Mortality results from a randomized prostate-cancer screening trial. N Engl J Med. 2009;360:1310-9.

3. Schroder FH, Hugosson J, Roobol MJ, Tammela TL, Zappa M, Nelen V, et al. Screening and prostate cancer mortality: results of the European Randomised Study of Screening for Prostate Cancer (ERSPC) at 13 years of follow-up. Lancet. 2014;384:2027-35.

4. Panach-Navarrete J, Carratala-Calvo A, Valls-Gonzalez L, Sales-Maicas M, Martinez-Jabaloyas JM. Prostate Specific Antigen (PSA) use in a national health department. Arch Esp Urol. 2015;68:647-54.

5. Chesa Ponce N, Orengo Valverde JC. Knowledge about PSA among primary care physicians. Arch Esp Urol. 2002;55:113-6.