The Continuing Role of PSA in the Detection and Management of Prostate Cancer

Despite being used extensively for the diagnosis and management of prostate cancer, prostate-specific antigen (PSA) testing remains controversial. Doubts have been raised over the continued use of PSA in the detection of clinically significant prostate cancer because many men now present with early-stage, small-volume tumours. This article examines the limitations of using a single PSA value in diagnosis and discusses alternative approaches to PSA testing, in particular PSA velocity and PSA doubling time, which are now emerging as valuable pretreatment disease predictors. A clinical scenario is also presented to illustrate the use of PSA kinetics in identifying candidates for biopsy.