SIU Virtual Congress 2020: Is Serum PSA Still a Standard Marker for Prostate Cancer: Do We Have Game Changers?

( In the Indian Urology Symposium held in conjunction with this year’s virtual Société Internationale d'Urologie (SIU) annual congress, Dr. Anant Kumar examined the question of biomarkers for prostate cancer, specifically whether there are any new “game changers” beyond serum prostate-specific antigen (PSA).

Dr. Kumar began highlighting the history of PSA. This protein was initially discovered in 1970 and was only used in prostate cancer diagnosis and management a decade later. While PSA is organ-specific, it is (as most UroToday readers will know) not disease process specific and elevations may be due to a variety of causes including infection, benign growth, or malignancy. Further, PSA levels vary between patients and on the basis of age, race and prostate volume.

Used in screening for prostate cancer, Dr. Kumar highlighted that United States guidelines from 2012 recommended against non-selective screening and a Cochrane review published shortly thereafter demonstrated no overall or prostate cancer-specific survival advantage to organized screening. However, as an independent variable, PSA is a better predictor of prostate cancer risk than other available variables, particularly when combined with digital rectal exam findings.


Dr. Kumar then discussed newer approaches using biomarkers such as free PSA, PHI test, 4Kscore, PCA3 assay, and MiPS score. However, he emphasized that the role for these biomarkers has diminished with the increasing role of imaging with multiparametric MRI.

Predictive nomograms may also be used, in each case, PSA plays an important role in risk stratification.

Moving forward in the disease process, Dr. Kumar emphasized that PSA is important for prognostication as well as the surveillance and assessment of treatment response. Among patients receiving systemic therapy with ADT, Dr. Kumar highlighted data from SWOG 9346 demonstrating the important prognostic value of PSA levels at 7 months following initiation of ADT.f


However, he emphasized important shortcomings including lower sensitivity in hypogonadal men, an interaction between both obesity and statin use with PSA levels, and the lack of PSA elevation associated with prostate cancers that are not adenocarcinoma (including neuroendocrine, squamous cell, and others).

Presented by: Anant Kumar, M.B.B.S., M.S., M.Ch., DNB, Chairman of Urology, Robotics and Kidney Transplantation at Max Hospital, Saket Delhi

Written by: Christopher J.D. Wallis, Urologic Oncology Fellow, Vanderbilt University Medical Center, Contact: @WallisCJD on Twitter at the 2020 Société Internationale d'Urologie Virtual Congress (#SIU2020), October 10th - October 11th, 2020