PSA Screening and Early Detection - Part 1. Guides

This series is mainly concerned with using the PSA test to detect prostate cancer in subjects who have not previously been known to have prostate cancer. Using PSA testing for detecting recurrence in patients after local therapy, monitoring advanced cancer and watchful waiting entry and exit criteria are different applications not specifically addressed in this series although there may be some relevant items scattered within the series. In particular the discussions of diagnostic testing concepts have general application even beyond prostate cancer.

It will be released in several parts:

PSA Screening and Early Detection. Part 1 - Guides [current]
PSA Screening and Early Detection. Part 2 - Key Points on PSA [next]
PSA Screening and Early Detection. Part 3. Current Environment
PSA Screening and Early Detection - Part 4. Diagnostic Testing Concepts
PSA Screening and Early Detection - Part 5. More Diagnostic Testing Concepts

Guides

It is recommended that the reader review the Australian mentioned below and possibly a variety of other guides and articles on PSA Testing which we list.

A particularly useful guide is this 4 page brochure from The Australian National Seniors Foundation guide (also found here). It has a surprising amount of detail despite its small size including a review of anatomy, disease statistics, pros and cons of testing, overall and age-specific cutoff levels, other causes of elevated PSA, Free PSA, interpreting PSA test and references. The age-specific cutoff points in that guide were pre-dated by the 1993 age-specific cutoffs published by Oesterling et al of the Mayo Clinic [PMID:7688054] shown on Page 4 Table 3 of this Mayo Clinic communique. He simplified them in 1995 in [PMID:75436] and it is this simplified version that is shown in the Australian guide. After Free Downloadable Brochures/Flyers/Pamphlets in Key Posts to the right,
[PSA] points to the Australian guide.

There are several one-page introductions to PSA available including Terry Herbert's patient-oriented introduction called PSA 101 and a second one pager on Herbert's site by Dr. Strum. The next introduction is a more epidemiologically oriented one pager of Ricardo Sanchez-Ortiz. Question 8 in the NCI Fact Sheet discusses variations on PSA that are being studied.

This useful guide from Ontario has separate web pages on frequently asked questions (FAQ), diagnosis, monitoring, quality assurance, guidelines and references. Be sure to check out its attractive multicolor diagram illustrating PSA test accuracy in the FAQ.

PSA Rising has a helpful decision chart for action after a PSA test. Another decision chart can be found in this 1998 Medscape article by Ricardo Beduschi.

PCRI has a useful article on PSA Testing as well as a more general 2 page summary pamphlet covering not only PSA but also nutrition and lifestyle. The PCRI site also has a lengthier two-part article by Jonathan McDermed: [Part I] [Part II].

Part I of a two-part 2005 article by Prof. William R. Ware starts on page 5 of [link] and discusses the PSA Test, its accuracy, pros and cons of testing, variations of the PSA test (such as Free PSA, PSA density, etc.) and other factors that affect PSA. In Part II which starts on page 7 of [link] Ware discusses the natural progression of prostate cancer in the absence of treatment.

Phoenix5 has a useful set of links to PSA Basics articles.

This 72-page 2002 Report from Ontario discusses epidemiology, pros and cons of testing, the major clinical trials and the guidelines that have come from various organizations.

We mention a few older articles as well.

This 18 page 1999 article by Brawer is mostly concerned with the variations on PSA such as Free PSA, PSA density, etc.

In this 100 page 1997 report from the UK, Chapter 3 on Diagnosis covers the various different PSA assays, variation in PSA levels, accuracy, age-specific cutoff values, PSA variations (Free PSA, PSA density, etc.) and Chapters 6 and 7 cover economics and epidemiology of screening. [link].

This 1996 article by Gleave et al (but without figures) discusses biological mechanisms.

Other guides similar to the one from Australia (but less detailed) are available from UK (short), UK (long), CDC and U of Maryland Medical Center.


PSA Screening and Early Detection. Part 1 - Guides [current]
PSA Screening and Early Detection. Part 2 - Key Points on PSA [next]
PSA Screening and Early Detection. Part 3. Current Environment
PSA Screening and Early Detection - Part 4. Diagnostic Testing Concepts
PSA Screening and Early Detection - Part 5. More Diagnostic Testing Concepts