Improving the Specificity of PSA Screening with Serum and Urine Markers

Prostate cancer remains a significant public health burden. In order to decrease the morbidity and mortality associated with prostate cancer, serum prostate-specific antigen (PSA) screening has been used since the 1990s. However, there is concern for overdiagnosis of prostate cancer with widespread PSA screening, which could lead to overtreatment and its attendant morbidities. In order to avoid unnecessary biopsy and downstream effects including treatment of insignificant prostate cancer, a number of tests have been proposed to improve upon PSA screening. Increasing the specificity of prostate cancer screening above that of PSA testing should reduce the incidence of unnecessary prostate biopsy. However, an increase in specificity is associated with a decrease in sensitivity, so these tests must be balanced with the concern for missing the diagnosis of potentially significant disease. In this context, we present a review of six common biomarkers proposed to improve the specificity of prostate cancer screening-free PSA, prostate health index, 4Kscore, PCA3, Select MDx, and ExoDx Prostate(Intelliscore).