About prostate cancer screening with the plasma prostate specific antigen (PSA) assay

Prostate cancer is the most frequent cancer in man above 50 years. There is an increase in its incidence due to the longer life of the population. Prostate cancer is a slowly progressing disease. If life expectation is smaller than 10 years, the risk of death from another cause is greater than that from cancer whereas it is the opposite in younger patients. Therefore, screening of the disease by rectal examination and prostatic specific antigen (PSA) assay is necessary confirmation being obtained by prostate biopsy. Total prostatectomy and radiotherapy can cure the disease or inhibit its progression. Plasma PSA is a general marker of prostate lesions. It is easy to measure and the cost of the assay is acceptable; but its specificity and its sensitivity remain too low. In order to improve these two parameters, it has been proposed to follow PSA kinetics and to measure the ratio free PSA/total PSA. Taken together these data lead us to recommend, in agreement with the French Association of Urology, that a PSA assay be proposed and a rectal examination be performed every year by a general practitioner in men between 50 and 75 years and from 45 years in case of familial history. If an anomaly is found, the patient must take advice from an urologist who will decide which examinations and which treatment are to be proposed. Moreover, studies are necessary to compare the principal treatments in the long term, to precise the distribution with age of plasma PSA in the population and to improve the specificity and the sensitivity of the screening test.