Michal Horňák, Vladimír Zvara
Objective: Until 2009 specialists groups recommended that early diagnosis of prostate cancer should begin at the age of 50 years for men at average risk, and sooner for those at higher risk (positive family history, African-American race). During 2009 guidelines for screening PSA by specialists groups recommended to begin early diagnosis from the age of 40 years in all men. The aim of this review article is to identify the reason for moving early diagnosis forward by a decade. Methods: By searching MEDLINE database the authors want to explain why early diagnosis of prostate cancer has been moved forward to the age of 40. Results: PSA testing obtained at a single occasion at the age of 40-50 is a very strong predictor of advanced prostate cancer subsequently. Current treatment strategy does not recommend that threshold PSA on its own should indicate biopsy of prostate. The decision to proceed to prostate biopsy should be based primarily on PSA and DRE results, but at the same time, many other factors including ratio between free to total PSA, patient’s age, PSAV, PSAD, family history, race, prior biopsy history and co-morbidities should be taken into account. Prior to performing biopsy patients should be informed about advantages and disadvantages of prostate screening and active surveillance in place of immediate treatment of diagnosed carcinoma. Conclusion: Early diagnosis and evaluation of risk of prostate cancer should begin in men from the age of 40 with subsequent PSA values that could help to identify men with life threatening prostate cancer at the time when curative treatment methods are available and therefore cure is possible. Men at the age of 40 whose PSA values are above the median of the age level (0.6-0.7 ng/ml) are in high risk of prostate cancer.