Prostate-Specific Antigen: A Misused and Maligned Prostate Cancer Biomarker

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Abstract
Prostate cancer is a conundrum. It is ubiquitous in aging men and, although the lifetime risk of death is only about 3%, it causes almost 30 000 deaths per year. The cancer is asymptomatic until metastatic and at that stage, median survival is about 3 years. The advent of prostate-specific antigen (PSA) testing in combination with ultrasound-guided biopsy has dramatically increased cancer detection; a PSA test result is currently the “prompt” for the majority of prostate biopsies, and although only about half of the population receives regular PSA testing, it has effectively doubled the lifetime risk of receiving a prostate cancer diagnosis. It is currently unclear to what extent PSA screening has decreased prostate cancer mortality, but overdiagnosis leading to treatment of cancer that would never metastasize is certain.