The Dilemma of Early Diagnosis for a Clinically Relevant Prostate Cancer: The Role of Urologist

The introduction and widespread adoption of Prostate-Specific Antigen (PSA) has revolutionized the diagnosis and treatment of prostate cancer (PCa). However, the use of PSA has also led to overdiagnosis and overtreatment of PCa resulting in controversy about its use for screening. PSA also has limited predictive accuracy for predicting outcomes after treatment and for making clinical decisions. Hence, there is a need for novel biomarkers or support in medical treatment to supplement PSA for an early detection and management of PCa. For the purpose of this section, we focus not only on PSA-derived forms, precursor forms of PSA, and the biomarker PCA3, but also on the use of 5α reductase inhibitors (5-ARI) therapy like a tool to better discriminate patients with or without aggressive cancer. However, we need in the future more data that permit that a panel of biomarkers will be used to achieve sufficient degree of certainty in order to guide clinical decisions making. In the early diagnosis of PCa, the second step is its histological confirmation at prostate biopsy (PBx). Although the random TRUS-guided biopsy remains the gold standard for PCa detection, it is now clear that we need for a more sensitive and accurate imaging modality to detect early PCa.