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© The Canadian Journal of Urology™; 18(Supplement 1); April 2011
Address correspondence to Dr. Jack Barkin, Chief of Staff,
Humber River Regional Hospital, 960 Lawrence Avenue
West, Suite 404, Toronto, Ontario M6A 3B5 Canada
PSA and the family physician
Jack Barkin, MD
Humber River Regional Hospital, University of Toronto, Toronto, Ontario
BARKIN J . PSA and the fami ly physician.
The Canadian Journal of Urology. 2011;18
(Supplement 1):20-23.
The need for men to undergo screening for prostate cancer
is controversial. Urologists are concerned about finding
many men with minimal disease who may not require
therapy or may be over-treated, while conversely missing
menwith clinically significant prostate cancer that could be
treated and cured if found at an early enough stage. Most
men today present to the physician with some symptoms
attributable to the prostate, and then have a prostate-
specific antigen (PSA) test to screen for prostate cancer.
PSA is still the most effective test to suggest that there may
be underlying prostate cancer. In addition to measuring
total PSA, other measures such as PSAdensity, age-related
PSA, or PSA velocity can provide further justification
that a patient should undergo a prostate biopsy to detect
possible cancer. The American Urological Association has
developed new guidelines for screening for prostate cancer
in men who are not at risk. The key is to use one of the PSA
tools to help diagnose prostate cancer at an early stage and
then offer aggressive curative therapy, if appropriate, while
still providing the best quality of life and least chance of
failure, in the right patient at the right time.
KeyWords:
prostate cancer, biopsy, prostate-specific
antigen, guideline
America. Physicians are diagnosing prostate cancer
at an earlier stage, and patients with this cancer are
surviving longer, and mortality from prostate cancer
has decreased. These improved outcomes are believed
to be due to increased awareness of risk factors for
prostate cancer (such as family history) and increased
use of PSAscreening to detect potential prostate cancer.
According to Dorland’s dictionary, “screening” is
“examination or testing of a group of individuals to
separate those who are well from those who have an
undiagnosed disease or defect or who are at high risk.”
Background
Prostate-specific antigen (PSA) is specific for the
prostate, but it is not specific for prostate cancer.
Prostate cancer is still the number one diagnosed
cancer in men in North America and it is the second-
most common cancer that causes death inmen inNorth
20