A total of 234 articles was retrieved for analysis. Additional articles were identified by review of the references cited in these publications.
Prostate cancer is now the most common type of cancer among men.
Since the advent of blood tests for measuring PSA, the incidence of prostate cancer increased through 1992, largely based on the detection of moderately differentiated tumors, then declined in conjunction with a stable or slightly declining mortality rate. Each procedure detects cancer missed by the other. The majority of tumors that are detected by PSA are organ-confined, but size and pathological characteristics indicate than many of these are clinically significant. The low specificity of PSA results in a number of false-positive tests in men with benign prostatic hyperplasia and a large number of diagnostic biopsies. Application of adjusted PSA ranges based on age or race to improve specificity is not widely validated at this time.