The routine use of prostate-specific antigen for early detection of cancer prostate in India: Is it justified?

Background: The use of prostate-specific antigen (PSA) for early detection of prostate cancer is a widely debated issue. The average Indian urologist is faced with the dilemma of whether PSA testing should be routinely offered to men over 50 years of age. The Urological Society of India is yet to issue any guidelines on PSA testing. This article attempts to explore scientific evidence dealing with this controversial subject. Materials and Methods: A MEDLINE search was performed using the words 'PSA screening', 'prostate cancer statistics', and 'PSA screening guidelines'. The relevant articles were then analysed for evidence regarding the utility of PSA screening. Results: Prostate cancer does not qualify to be categorized as a major health problem in India. The natural history of screendetected cancer is not known. Prostate-specific antigen testing for early detection of prostate cancer has questionable benefits and has a potential to cause harm to asymptomatic individuals. There is no consensus amongst learned medical societies as to what should be the best approach for PSA testing. Most organizations caution against widespread PSA screening and emphasize on informed consent and patient counseling with regard to PSA testing. Randomized prospective trials are ongoing to assess to the true impact of screening on prostate cancer mortality. Conclusions: There is no scientific rationale to advocate routine use of PSA for early detection of prostate cancer in Indian males. Results of randomized screening trials are awaited to clarify on this issue.