Editing Prostate-specific antigen (section)

====Screening====
{{Main|Prostate cancer screening}}

[[Clinical practice guideline]]s for prostate cancer [[screening (medicine)|screening]] vary and are controversial, in part due to uncertainty as to whether the benefits of screening ultimately outweigh the risks of [[overdiagnosis]] and overtreatment.<ref name="Gomella-2011">{{cite journal | vauthors = Gomella LG, Liu XS, Trabulsi EJ, Kelly WK, Myers R, Showalter T, Dicker A, Wender R | title = Screening for prostate cancer: the current evidence and guidelines controversy | journal = The Canadian Journal of Urology | volume = 18 | issue = 5 | pages = 5875–5883 | date = October 2011 | pmid = 22018148 }}</ref> In the United States, the [[Food and Drug Administration]] (FDA) has approved the PSA test for annual screening of prostate cancer in men of age 50 and older.{{medcn|date=July 2020}} The patient is required to be informed of the risks and benefits of PSA testing prior to performing the test.{{medcn|date=July 2020}}

In the United Kingdom, the [[National Health Service]] (NHS) {{As of|2018|lc=y}} does not mandate, nor advise for PSA test, but allows patients to decide based on their doctor's advice.<ref>{{cite web | url = https://www.nhs.uk/livewell/prostatehealth/pages/psa-test.aspx | title = Should I have a PSA test? | archive-url = https://web.archive.org/web/20180228163153/https://www.nhs.uk/livewell/prostatehealth/pages/psa-test.aspx | archive-date = 28 February 2018| work = NHS Choices | date = 27 February 2018 }}</ref> The NHS does not offer general PSA screening, for similar reasons.<ref>{{cite web|title=Prostate cancer - PSA testing - NHS Choices|url=http://www.nhs.uk/Conditions/Cancer-of-the-prostate/Pages/Prevention.aspx|publisher=NHS Choices|language=en|date=3 January 2015}}</ref>

PSA levels between 4 and 10{{nbsp}}ng/mL (nanograms per milliliter) are considered to be suspicious, and consideration should be given to confirming the abnormal PSA with a repeat test. If indicated, [[prostate biopsy]] is performed to obtain a tissue sample for histopathological analysis. {{citation needed|date=May 2021}}

While PSA testing may help 1 in 1,000 avoid death due to prostate cancer, 4 to 5 in 1,000 would die from prostate cancer after 10 years even with screening. This means that PSA screening may reduce mortality from prostate cancer by up to 25%. Expected harms include anxiety for 100–120 receiving false positives, biopsy pain, and other complications from biopsy for false positive tests.{{medcn|date=July 2020}}

Use of PSA screening tests is also controversial due to questionable test accuracy. The screening can present abnormal results even when a man does not have cancer (known as a [[False positives and false negatives|false-positive result]]), or normal results even when a man does have cancer (known as a [[False positives and false negatives|false-negative result]]).<ref>{{Cite web|url=https://www.cancer.org/cancer/prostate-cancer/detection-diagnosis-staging/detection.html|title=Can Prostate Cancer Be Found Early?|website=www.cancer.org|language=en|access-date=2020-01-17}}</ref> False-positive test results can cause confusion and anxiety in men, and can lead to unnecessary prostate [[Biopsy|biopsies]], a procedure which causes risk of pain, infection, and [[Bleeding|hemorrhage]]. False-negative results can give men a false sense of security, though they may actually have cancer.{{medcn|date=July 2020}}

Of those found to have prostate cancer, overtreatment is common because most cases of prostate cancer are not expected to cause any symptoms due to low rate of growth of the prostate tumor. Therefore, many will experience the side effects of treatment, such as for every 1000 men screened, 29 will experience erectile dysfunction, 18 will develop urinary incontinence, two  will have serious cardiovascular events, one will develop pulmonary embolus or deep venous thrombosis, and one perioperative death.{{Failed verification|date=February 2020}} Since the expected harms relative to risk of death are perceived by patients as minimal, men found to have prostate cancer usually (up to 90% of cases) elect to receive treatment.<ref name="screening">{{cite web |url=http://www.uspreventiveservicestaskforce.org/prostatecancerscreening/prostatecancerscript.pdf |title=Talking With Your Patients About Screening for Prostate Cancer |access-date=2012-07-02 |archive-url=https://web.archive.org/web/20141011150935/http://www.uspreventiveservicestaskforce.org/prostatecancerscreening/prostatecancerscript.pdf |archive-date=11 October 2014 |url-status=dead }}</ref><ref name="Grossman-2018">{{cite journal | vauthors = Grossman DC, Curry SJ, Owens DK, Bibbins-Domingo K, Caughey AB, Davidson KW, Doubeni CA, Ebell M, Epling JW, Kemper AR, Krist AH, Kubik M, Landefeld CS, Mangione CM, Silverstein M, Simon MA, Siu AL, Tseng CW | title = Screening for Prostate Cancer: US Preventive Services Task Force Recommendation Statement | journal = JAMA | volume = 319 | issue = 18 | pages = 1901–1913 | date = May 2018 | pmid = 29801017 | doi = 10.1001/jama.2018.3710 | doi-access = free }}</ref><ref name="Fenton-2018">{{cite journal | vauthors = Fenton JJ, Weyrich MS, Durbin S, Liu Y, Bang H, Melnikow J | title = Prostate-Specific Antigen-Based Screening for Prostate Cancer: Evidence Report and Systematic Review for the US Preventive Services Task Force | journal = JAMA | volume = 319 | issue = 18 | pages = 1914–1931 | date = May 2018 | pmid = 29801018 | doi = 10.1001/jama.2018.3712 | doi-access = free }}</ref>