Prostate cancer screening: current state of the problem

Introduction. Prostate cancer screening remains a controversial subject and a subject of wide discussion, as it has not only potential benefits, but also negative consequences. Materials and methods. A review of the literature showed that screening for prostate cancer using a prostate specific antigen (PSA) test reduces overall mortality from this disease. The key to deciding on screening for prostate cancer is the need to discuss between the doctor and the patient all the positive and negative aspects of screening. Results. The PSA total fraction test is recognized as the most preferred tool for screening for prostate cancer and assessing the risk of metastasis and death from it. However, there is no single position regarding age for screening using PSA. Various screening start times are recommended: 45, 50 and 55 years. Intervals for re-screening may be different depending on the risk, which is calculated on the basis of indicators of age, general health and baseline PSA. Long intervals between repeated screening examinations are recommended for people at low risk of developing prostate cancer, and short intervals for people at high risk. Many additional tests have been proposed, the use of which will reduce the frequency of overdiagnosis of prostate cancer and unnecessary biopsies. Commonly recognized risk factors for prostate cancer are the family history of the disease and African-American affiliation. But there is no consensus on screening for people with an increased risk of prostate cancer: some professional societies offer to start testing PSA at the age of 45 years, and others only after discussing the significance of this risk for each person individually. Many international guidelines do not recommend routinely using multiparametric magnetic resonance imaging for screening for prostate cancer, but rather allow it to be used in individuals with persistent elevated PSA levels and previous negative prostate biopsies. Conclusions. Thus, the data presented reflect the main approaches and contradictions in the screening of prostate cancer, which can be taken into account and used in organizing regional or federal programs for screening for prostate cancer.