![]() For all these reasons, the US and the Canadian Task Force on Preventive Health Care recently released independent statements arguing that the risks of PSA tests outweigh the benefits. Systematic TRUS biopsy has historically shown to underestimate the final Gleason grade of tumor on histology following radical prostatectomy, leading to inaccurate risk stratification and selection of therapeutic options. ![]() On the other hand, anterior tumors tend to be missed by TRUS biopsy until they grow to a substantial size and reach within 15–20 mm from the posterior margin of the prostate, leading to delayed diagnosis. This has come with the risk of overdiagnosis and overtreatment, as many of these are clinically insignificant low-risk prostate cancer. About 233,000 new prostate cancers are estimated to be diagnosed in 2014 in the USA. Use of PSA as a screening tool followed by systematic transrectal ultrasound-guided (TRUS) biopsy has resulted in increased detection of prostate cancer with stage migration toward low-risk disease. Currently, the diagnostic pathway for prostate cancer detection is initiated on prostate-specific antigen (PSA) level and digital rectal exam (DRE).
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