Prostate-Specific–Antigen Testing for Early Diagnosis of Prostate Cancer

This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the author's clinical recommendations.A 65-year-old man with no risk factors for prostate cancer except his age has a normal digital rectal examination. Should a prostate-specific–antigen (PSA) test be ordered?The Clinical ProblemThe introduction of PSA testing in 1987 resulted in an enormous increase in the reported incidence of prostate cancer in the United States. After peaking in 1992, the incidence fell, presumably owing to the identification of preexisting cases among men who had been tested. The rate of death from prostate cancer has risen and fallen over the same period for reasons that are unclear (Figure 1).1 Advocates of screening attribute . . .