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El número de casos de cáncer de próstata ha aumentado de forma espectacular en los últimos 25 años. La razón ha sido la adopción global de hacer el PSA (Antígeno Prostático Específico) para diagnosticar este cáncer en su etapa inicial.

Los partidarios de realizar el PSA a todos los hombres se basan en los datos de un gran estudio (ERSPC), que sugería que este marcador en sangre podía reducir la mortalidad a largo plazo además de un descenso del número de cánceres de próstata avanzados dado que se diagnostican mucho antes.

Los detractores de realizar el PSA argumentan que el cáncer de próstata tiene una historia natural indolente en muchos hombres y que, en términos globales, las campañas de PSA no tienen impacto en la mortalidad global del varón. Además, se sobrediagnostican muchos hombres sometiéndoles a biopsias innecesarias y dados que son diagnosticados en muchos casos de cánceres de próstata poco agresivos, muchos se ven sometidos a los efectos secundarios de la radioterapia o cirugía, sin compensar los modestos beneficios de este masivo análisis.

Las Guías Clínicas del Panel de expertos canadienses están en contra de hacer el PSA de forma rutinaria a todos los hombres entre 55 y 69 años. Sin embargo, el Panel de Expertos Norteamericanos ha cambiado de opinión recientemente recomendando que debe ser una decisión individual entre el urólogo y su paciente valorando los pros y contras de este análisis. El National Cancer Center Network (NCCN), que aglutina a los centros de cáncer en los EEUU, recomienda iniciar la realización de un PSA a los 45 años. Por último, las Guías Clínicas de la Asociación Americana de Urología (AUA) y de la Asociación Europea de Urología (EAU) recomiendan una discusión con el paciente. Como pueden apreciar, hay toda una disparidad de criterios en relación si se debe realizar o no.

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