Editing AUA: Early Detection of Prostate Cancer (2023) (section)

=== Tests to use in prostate cancer screening ===
*'''<span style="color:#ff0000">Use PSA as the first screening test</span>'''
** '''<span style="color:#ff0000">Digital rectal exam (DRE)</span>'''
***'''<span style="color:#ff0000">Clinicians should not use DRE as the sole screening method.</span>'''
****'''The primary screening modality recommended for the early detection of prostate cancer is a PSA blood test.''' 
*** '''<span style="color:#ff0000">Insufficient evidence to support adding DRE to PSA-based prostate cancer screening.</span>'''
**** For various reasons, clinicians may choose to complement PSA screening with DRE based on SDM.
**'''Stockholm-3 (STHLM-3)'''
***Multiplex test combining 
****Clinical variables (age, first-degree family history of prostate cancer, and previous biopsy)
****Blood biomarkers (total PSA, free PSA, ratio of free to total PSA, hK2, MIC-1, and MSMB)
****Polygenic risk score (PRS)
***Has been evaluated as a first-line screening test for predicting the risk of GG2+ prostate cancers.[https://pubmed.ncbi.nlm.nih.gov/26563502/]
****STHLM-3 found to have a higher predictive accuracy compared to PSA alone (area under the curve [AUC] 0.74 versus 0.56) and reduced unnecessary biopsies by 32%
****Further validation in diverse populations to confirm these findings will be necessary to move forward into practice.
** '''Polygenic risk score (PRS)''' 
***Genetic tests used to predict a person’s risk of developing prostate cancer.
***Typically constructed as the weighted sum of a collection of genetic variants, usually single nucleotide polymorphisms (SNPs) defined as single base-pair variations from the reference genome[https://pubmed.ncbi.nlm.nih.gov/35251129/] 
***Little evidence to mandate which SNP panel or PRS to use and where to threshold risk to create strata with different screening intensities.
***At the time of evidence review, no PRS tool has been shown to discriminate between aggressive and indolent prostate cancer risk