Update on Prostate-Specific Antigen Testing for the Early Detection of Prostate Cancer

The introduction of prostate-specific antigen (PSA) has revolutionized the detection and management of men with prostate cancer (PCa). This review discusses the clinically useful risk factors associated with the development of PCa and the salient features of PSA. It will help to highlight the abilities and limitations of PSA with respect to the diagnosis and management of PCa. Emphasis will be placed on the factors affecting serum total PSA (tPSA) levels, the optimal cutoff values, the use of calculated parameters such as PSA density, PSA transition zone density, PSA velocity, age- and racespecific PSA ranges, and the various molecular forms. There is an imminent need for novel biomarkers that can improve specificity for PCa, allow accurate classification of clinically insignificant PCa, allow for detection of clinically significant PCa in patients without elevated serum PSA, and allow for the identification of aggressive forms of PCa, which may warrant adjunctive or even molecularly targeted therapy in the future. Upon completion of this exercise, readers should be able to identify risk factors for prostate cancer (PCa) and assess their impact on the thresholds of serum tPSA levels with respect to optimal performance in detecting PCa; define the ideal age to begin screening for PCa in men possessing highrisk characteristics; understand factors other than PCa affecting serum tPSA levels and assess their impact on the thresholds of serum tPSA levels with respect to optimal performance in the detection of PCa; and discuss the diagnostic performance of lower thresholds for serum tPSA testing in screening for and in diagnosing PCa.