In the pre-PSA-detection era, a large proportion of men were diagnosed with metastatic prostate cancer and died of the disease; after the introduction of the serum PSA test, randomized controlled prostate cancer screening trials in the USA and Europe were conducted to assess the effect of PSA screening on prostate cancer mortality. Contradictory outcomes of the trials and the accompanying overdiagnosis resulted in recommendations against prostate cancer screening by organizations such as the United States Preventive Services Task Force. These recommendations were followed by a decline in PSA testing and a rise in late-stage diagnosis and prostate cancer mortality. Re-evaluation of the randomized trials, which accounted for contamination, showed that PSA-based screening does indeed reduce prostate cancer mortality; however, the debate about whether to screen or not to screen continues because of the considerable overdiagnosis that occurs using PSA-based screening. Meanwhile, awareness among the population of prostate cancer as a potentially lethal disease stimulates opportunistic screening practices that further increase overdiagnosis without the benefit of mortality reduction. However, in the past decade, new screening tools have been developed that make the classic PSA-only-based screening an outdated strategy. With improved use of PSA, in combination with age, prostate volume and with the application of prostate cancer risk calculators, a risk-adapted strategy enables improved stratification of men with prostate cancer and avoidance of unnecessary diagnostic procedures. This combination used with advanced detection techniques (such as MRI and targeted biopsy), can reduce overdiagnosis. Moreover, new biomarkers are becoming available and will enable further improvements in risk stratification.

在PSA检测之前的时代，很大一部分男性被诊断出患有转移性前列腺癌并死于该病；引入血清PSA检测后，美国和欧洲进行了随机对照前列腺癌筛查试验，以评估PSA筛查对前列腺癌死亡率的影响。这些试验的矛盾结果以及随之而来的过度诊断导致美国预防服务工作组等组织建议反对前列腺癌筛查。这些建议之后，PSA 检测量下降，晚期诊断率和前列腺癌死亡率上升。对随机试验的重新评估（考虑了污染）表明，基于 PSA 的筛查确实可以降低前列腺癌死亡率；然而，由于使用基于 PSA 的筛查会出现相当大的过度诊断，因此关于是否进行筛查的争论仍在继续。与此同时，人们对前列腺癌作为一种潜在致命疾病的认识刺激了机会主义筛查做法，进一步增加了过度诊断，而没有降低死亡率。然而，在过去十年中，新的筛查工具的开发使得经典的仅基于 PSA 的筛查成为过时的策略。通过改进 PSA 的使用，结合年龄、前列腺体积以及前列腺癌风险计算器的应用，风险适应策略可以改善前列腺癌男性的分层并避免不必要的诊断程序。这种组合与先进的检测技术（例如 MRI 和靶向活检）结合使用，可以减少过度诊断。 此外，新的生物标志物正在出现，并将进一步改善风险分层。