PSA Screening

Question 1

What does PSA stand for?

Answer 1

Prostate Specific Antigen.

Question 2

Where is PSA produced?

Answer 2

By epithelial cells of the prostate gland.

Question 3

What is the rationale for PSA screening?

Answer 3

To detect prostate cancer at an early, potentially curable stage.

Question 4

Is PSA testing currently used as a national screening tool in the UK?

Answer 4

No — the UK does not run a national PSA screening programme.

Question 5

Why is PSA not recommended for population-wide screening?

Answer 5

Because it has limited specificity and can lead to overdiagnosis and overtreatment.

Question 6

What is a key benefit of PSA screening?

Answer 6

Early detection of prostate cancer before symptoms develop.

Question 7

How can early detection improve outcomes?

Answer 7

Increases the chance of successful treatment and long-term survival.

Question 8

What population might particularly benefit from PSA testing?

Answer 8

Men at higher risk (e.g., those with family history, Black men).

Question 9

What did large trials (e.g., ERSPC) suggest about PSA screening?

Answer 9

It may reduce prostate-cancer–specific mortality.

Question 10

How can PSA be useful besides cancer screening?

Answer 10

It can monitor known prostate disease and track progression.

Question 11

Why is PSA considered a non-specific test?

Answer 11

Levels can rise due to benign causes like prostatitis, BPH, or recent ejaculation.

Question 12

What problem does PSA screening have with sensitivity?

Answer 12

Some prostate cancers do not raise PSA, leading to false negatives.

Question 13

How does PSA screening contribute to overdiagnosis?

Answer 13

It detects slow-growing cancers that would never cause harm during a man’s lifetime.

Question 14

Why is overdiagnosis a concern?

Answer 14

It leads to unnecessary biopsies, anxiety, and treatments with side effects.

Question 15

What side effects can result from overtreatment of low-risk prostate cancer?

Answer 15

Incontinence, erectile dysfunction, bowel problems.

Question 16

What invasive test typically follows an abnormal PSA?

Answer 16

Prostate biopsy.

Question 17

What are risks associated with prostate biopsy?

Answer 17

Infection, bleeding, pain, and sometimes hospitalisation.

Question 18

Why is informed decision-making essential for PSA testing?

Answer 18

Benefits and harms vary widely, so men must understand the trade-offs.

Question 19

What inequality concern exists in PSA screening?

Answer 19

High-risk groups (e.g., Black men) may benefit more, but may be less likely to access testing.

Question 20

What ethical dilemma exists around false positives?

Answer 20

They cause psychological distress and unnecessary procedures.

Question 21

Why is it difficult to balance screening benefits with harms?

Answer 21

Mortality benefit is modest, but harms (e.g., overtreatment) are significant.

Question 22

How has MRI changed PSA screening pathways?

Answer 22

Pre-biopsy MRI helps reduce unnecessary biopsies.

Question 23

What is “risk-adapted screening”?

Answer 23

Using risk factors (age, family history, ethnicity) to target PSA testing more effectively.

Question 24

What additional biomarkers may improve screening accuracy?

Answer 24

Free-to-total PSA ratio, PSA density, PSA velocity, PHI (Prostate Health Index).

Question 25

How does active surveillance help manage overdiagnosis?

Answer 25

Allows monitoring low-risk cancers without immediate treatment.

Question 26

What is the main challenge in PSA screening programmes?

Answer 26

Balancing early detection benefits with harms of overdiagnosis and overtreatment.

Question 27

Why is informed choice emphasised in PSA testing policies?

Answer 27

Because screening outcomes vary, and personal values affect decisions.

Question 28

What guidance is typically given to men requesting PSA testing?

Answer 28

They should be counselled about potential benefits and risks before testing.