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Prostate-specific antigen (PSA) is a glycoprotein enzyme secreted by the prostate gland. PSA is produced for the ejaculate, where it liquefies semen and allows sperm to swim freely.

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PSA tests for prostate cancer screening

Men’s opinions on prostate cancer screening vary greatly: Some prefer not to think about it at all, while others want to take every opportunity to try to prevent prostate cancer. Either way, anyone looking into the topic of prostate cancer screening will come across conflicting information and advice, and that can make it harder to decide whether or not to be screened.The confusion starts with the various ways the examinations are talked about. Screening is sometimes referred to as prostate cancer prevention, which can give you the impression that screening can keep you from developing cancer. But none of the examinations currently offered can do that. The goal of screening is to detect prostate cancer as early as possible in the hope of increasing the chances of successful treatment.Prostate cancer is different in different men: Sometimes it grows so slowly that no treatment is needed. But it can also be aggressive, cause problems or even become life-threatening. Fortunately, most prostate cancer tumors are the slow-growing type.The only screening test for prostate cancer that has been investigated in larger studies is the PSA test. This test is designed to detect prostate cancer before it starts causing symptoms, and in turn give men better treatment options and increase their life expectancy. But PSA testing is a controversial issue. As with any screening test, the results of PSA tests are sometimes wrong, and there are some clear disadvantages too. So it is worth carefully weighing the pros and cons of the test before deciding on whether or not to have it.In Germany, PSA tests for prostate cancer screening are not covered by statutory health insurers. But many doctors offer the test as an individual health care service, which need to be paid out of pocket. The test costs about 15 to 20 euros. Because it involves a consultation and other related tests it often ends up costing around 50 euros.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: January 28, 2015

The accuracy of f/t-PSA for diagnosing prostate cancer with a t-PSA level of 4-10ng/mL: a systematic review and meta-anlysis

Bibliographic details: Guo XF, Xu HN, Zhang XY, Wang HL, Shi JP.  The accuracy of f/t-PSA for diagnosing prostate cancer with a t-PSA level of 4-10ng/mL: a systematic review and meta-anlysis. Chinese Journal of Evidence-Based Medicine 2010; 10(10): 1164-1168

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2010

PCA3 Testing for the Diagnosis and Management of Prostate Cancer [Internet]

We performed a comparative effectiveness review that examined the use of the prostate cancer antigen 3 (PCA3) gene in improving initial or repeat biopsy decisions in patients identified at risk for prostate cancer, or in improving decisionmaking about treatment choices (e.g., active surveillance vs. aggressive therapy) in patients with prostate cancer positive biopsies. Comparators included total prostate specific antigen (PSA) elevations, free PSA, PSA density, PSA velocity, externally validated nomograms, complexed PSA, and multivariate models.

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US).

Version: April 2013
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Prostate Cancer: Diagnosis and Treatment

The original Prostate Cancer: Diagnosis and Treatment Guideline published in 2008 was the first clinical guideline produced by the National Collaborating Centre for Cancer (NCC-C); accordingly this is now the first NCC-C clinical guideline to be reviewed and updated. Many areas of the original guideline are unchanged as there is little or no new evidence; other aspects have been completely rewritten. As ever there are still many topics where the research evidence is incomplete or conflicting, and so the Guideline Development Group (GDG) have been required to reach a consensus using the evidence available to them in several areas. In places where it was clear that further work needed to be done, new research recommendations have been made which we hope will be used as the basis for future research work.

NICE Clinical Guidelines - National Collaborating Centre for Cancer (UK).

Version: January 2014
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Transient Loss of Consciousness (‘Blackouts’) Management in Adults and Young People [Internet]

There are a number of existing guidelines, for epilepsy, falls and cardiac arrhythmias; which all relate to transient loss of consciousness (TLoC), but there is no guideline which addresses the initial assessment and management of patients who blackout. As such patients may come under the care of a range of clinicians, the lack of a clear pathway contributes to their misdiagnosis, and inappropriate treatment.

NICE Clinical Guidelines - National Clinical Guideline Centre for Acute and Chronic Conditions (UK).

Version: August 2010
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Prostate-specific antigen (PSA) isoform p2PSA in prostate cancer screening: systematic review of current evidence and further perspectives

Bibliographic details: Lippi G, Aloe R, Mattiuzzi C.  Prostate-specific antigen (PSA) isoform p2PSA in prostate cancer screening: systematic review of current evidence and further perspectives. Rivista Italiana della Medicina di Laboratorio 2012; 8(4): 231-238

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

Reduction in uptake of PSA tests following decision aids: systematic review of current aids and their evaluations

A man's decision to have a prostate-specific antigen (PSA) test should be an informed one. We undertook a systematic review to identify and appraise PSA decision aids and evaluations. We searched 15 electronic databases and hand-searched key journals. We also contacted key authors and organisations. All decision aids and evaluations that discussed PSA were included, with meta-analyses performed on two outcomes from the evaluations: PSA testing and patient knowledge of PSA and related issues. Seven decision aids and 11 evaluations were included. The meta-analysis showed a significantly reduced probability in PSA testing after a decision aid: -3.5% (95% confidence interval: 0.0 to 7.2%; P = 0.050). There were significant improvements in knowledge within 2 weeks after a decision aid: 19.5% (95% confidence interval: 14.2 to 24.8%; P < 0.001). The effect on knowledge was less pronounced within 12-18 months after a decision aid: 3.4% (95% confidence interval: -0.7 to 7.4%; P = 0.10). PSA decision aids improve knowledge about PSA testing, at least in the short term. Men given these decision aids seem to be less likely to have the PSA test.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2005

Medicines for Psoriatic Arthritis: A Review of the Research for Adults

This summary will tell you about DMARDs, a type of medicine for people with PsA. It will also discuss the possible side effects of these medicines. It will tell you what research has found about how well DMARDs work to treat PsA. This summary can help you talk with your doctor about whether one of these medicines might be right for you. This summary does not discuss treatments for the skin condition of psoriasis.

Comparative Effectiveness Review Summary Guides for Consumers [Internet] - Agency for Healthcare Research and Quality (US).

Version: November 20, 2012

Measurement of GSTP1 promoter methylation in body fluids may complement PSA screening: a meta-analysis

BACKGROUND: Prostate-specific antigen (PSA) screening has low specificity. Assessment of methylation status in body fluids may complement PSA screening if the test has high specificity.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2011

Tumour necrosis factor inhibitor monotherapy vs combination with MTX in the treatment of PsA: a systematic review of the literature

OBJECTIVES: The aim of this study was to review the available evidence on TNF inhibitor monotherapy vs combination therapy with MTX in PsA.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

Use of prostate-specific antigen (PSA) isoforms for the detection of prostate cancer in men with a PSA level of 2-10 ng/mL: systematic review and meta-analysis

This well-conducted review assessed the accuracy of the ratio of free to total prostate-specific antigen (PSA) and complexed PSA for detecting prostate cancer among men with total PSA levels between 2 and 10 ng/mL. The authors concluded that these tests can reduce the number of unnecessary biopsies whilst maintaining high cancer detection rates. These conclusions are questionable as the results presented suggest that these tests produce a high number of false positives.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2005

Prostate-Specific Antigen-Based Screening for Prostate Cancer: An Evidence Update for the U.S. Preventive Services Task Force [Internet]

In 2008, the U.S. Preventive Services Task Force (USPSTF) concluded that the evidence was insufficient to assess the balance of benefits and harms of screening for prostate cancer in men younger than age 75 years. The USPSTF recommended against screening for prostate cancer in men aged 75 years or older.

Evidence Syntheses - Agency for Healthcare Research and Quality (US).

Version: October 2011
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Why has prostate cancer become so common?

The aim of screening for prostate cancer is to lower the risk of dying of the disease later on. One disadvantage of prostate cancer screening is that it can detect cancerous growths that never would have caused any symptoms. Diagnoses based on screening have made prostate cancer the most common type of cancer in men.Prostate cancer is the most commonly diagnosed type of cancer in men. In Germany alone, about 67,000 men are now diagnosed every year. This diagnosis was a lot less common 30 years ago: in 1980, for example, just over 20,000 men were diagnosed with prostate cancer per year.Cancer is slowly but surely becoming more common in general. One reason for this is the increase in life expectancy. Cancer – including prostate cancer – is most common in older people. Because more and more people are living to 70, 80 or 90, the number of people who have cancer is going up too.But when it comes to prostate cancer, gains in life expectancy are not the main reason why it has become more common. This can be shown by examining changes in life expectancy using a statistical approach called age adjustment.The illustration below shows the results: the number of men out of 100,000 who have had prostate cancer and how many have died of it per year since 1980 – assuming that the average age of men has remained constant.According to these figures, the rate of diagnosis has roughly doubled. In 1980, 53 out of 100,000 men developed prostate cancer, compared to about 110 out of 100,000 in 2008. At the same time the risk of dying of the disease has dropped: from 25 to about 20 out of 100,000 men. 

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: March 1, 2013

Prostate cancer: Overview

Prostate cancer is a malignant tumor in the prostate, a gland that is part of the male internal reproductive system. The prostate is a gland about the size of a chestnut, and is located between the bladder and the pelvic floor muscles.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: March 28, 2013

Benign enlarged prostate: Overview

Many middle-aged men will know what it is like to have to go to the bathroom a lot at night and still feel like your bladder is never really empty. This problem is usually caused by a benign enlarged prostate. Here we describe the various treatment options for this condition.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: January 15, 2014

Palivizumab for Immunoprophylaxis of Respiratory Syncytial Virus (RSV) Bronchiolitis in High-Risk Infants and Young Children: Systematic Review and Additional Economic Modelling of Subgroup Analyses

Respiratory syncytial virus (RSV) is a seasonal infectious disease, with epidemics occurring annually from October to March in the UK. It is a very common infection in infants and young children and can lead to hospitalisation, particularly in those who are premature or who have chronic lung disease (CLD) or congenital heart disease (CHD). Palivizumab (Synagis®, MedImmune) is a monoclonal antibody designed to provide passive immunity against RSV and thereby prevent or reduce the severity of RSV infection. It is licensed for the prevention of serious lower respiratory tract infection caused by RSV in children at high risk. While it is recognised that a policy of using palivizumab for all children who meet the licensed indication does not meet conventional UK standards of cost-effectiveness, most clinicians feel that its use is justified in some children.

Health Technology Assessment - NIHR Journals Library.

Version: January 2011
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Suicide Prevention Interventions and Referral/Follow-Up Services: A Systematic Review [Internet]

Suicide is the tenth leading cause of death in the United States (US), with nearly 100 suicides occurring each day and over 36,000 dying by suicide each year. Among Veterans and current military, suicide is a national public health concern. Recent estimates suggest current or former military represent 20 percent of all known suicides in the US and the rate of suicides among Veterans utilizing Veterans Health Administration (VHA) services is estimated to be higher than the general population. The enormity of the problem has led to several major public health initiatives and a growth in research funding for suicide prevention.

Evidence-based Synthesis Program - Department of Veterans Affairs.

Version: March 2012
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Hypertension: The Clinical Management of Primary Hypertension in Adults: Update of Clinical Guidelines 18 and 34 [Internet]

NICE first issued guidance for the management of hypertension in primary care in 2004. This was followed by a rapid update of the pharmacological treatment chapter of the guideline in 2006. The current partial update of the hypertension guideline is in response to the regular five year review cycle of existing NICE guidance. It began with a scoping exercise which identified key areas of the existing guideline for which new evidence had emerged that was likely to influence or change existing guideline recommendations.

NICE Clinical Guidelines - National Clinical Guideline Centre (UK).

Version: August 2011
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Biologic and Nonbiologic Systemic Agents and Phototherapy for Treatment of Chronic Plaque Psoriasis [Internet]

To examine the comparative effectiveness of biologic systemic agents versus nonbiologic systemic agents or phototherapy, on an individual drug level, for treatment of chronic plaque psoriasis (CPP) and to determine patient and disease characteristics that modify outcomes of interest.

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US).

Version: November 2012
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Clopidogrel and Modified-Release Dipyridamole for the Prevention of Occlusive Vascular Events (Review of Technology Appraisal No. 90): A Systematic Review and Economic Analysis

Occlusive vascular events such as myocardial infarction (MI), ischaemic stroke and transient ischaemic attack (TIA) are the result of a reduction in blood flow associated with an artery becoming narrow or blocked through atherosclerosis and atherothrombosis. Peripheral arterial disease is the result of narrowing of the arteries that supply blood to the muscles and other tissues, usually in the lower extremities. The primary objective in the treatment of all patients with a history of occlusive vascular events and peripheral arterial disease is to prevent the occurrence of new occlusive vascular events.

Health Technology Assessment - NIHR Journals Library.

Version: September 2011
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