Prostate cancer Prostate-specific antigen (PSA) screening is a controversial topic because a large number of people need to be screened annually in order to benefit from it, but this high frequency of screening does not seem to be proportional to the ultimate benefit. Most people have normal test results, and many are biopsied for transient PSA elevations, often resulting in low-risk, inconsequential tumors (which may have no effect on the body at all). Studies have shown that baseline PSA levels can predict the development of prostate cancer (PCa). To assess the utility of baseline PSA levels, Jonathan and others at the University of Texas Health Science Center at San Antonio conducted a cohort study and found that people with baseline PSA levels between 0.1 and 1.0 ng/mL had extended PSA screening frequency up to every 10 years Once every 10 years. The article was published in a recent issue of The Journey of Urology. The study included 2923 non-PCa subjects who underwent annual PSA screening and rectal exams (DRE) with a median follow-up of 7.5 years. Baseline PSA levels were categorized into six groups: 0.0 to 1.0 ng/mL; 1.1 to 1.5 ng/mL; 1.6 to 2.0 ng/mL; 2.1 to 2.5 ng/mL; 2.6 to 3.0 ng/mL; and 3.1 to 10.0 ng/mL. The relative risk of PCa detection in each PSA level group was assessed after adjusting for confounding factors of race, age, and family history. The relative risk of PCa detection in each group was assessed after adjusting for confounding factors of race, age and family history. A total of 289 patients with PCa were identified during follow-up, and subjects with baseline PSA levels of 0.1 to 1.0 ng/mL had a significantly lower risk of PCa. Half of this cohort had a PSA ≤ 1.0 ng/mL, while the risk of PCa within 10 years was only 3.4% and 90% of the tumors were low risk. In contrast, the other half of the subjects had a 15% to 39% risk of PCa, with a higher risk in the group with a baseline PSA of 3 to 10 ng/mL (39%). Although the risk of PCa varied slightly by race, age, and family history, the overall lower baseline PSA levels predicted a lower intermediate risk of PCa. Overall, a reasonable frequency of PSA screening should be extended to once every 10 years for those with baseline PSA levels between 0.1 and 1.0 ng/mL. This would greatly reduce the cost of screening, reduce over-testing and treatment of low-risk tumors, and focus more resources on other tests and treatments that could reduce the risk of death from PCa. However, this study had a short follow-up period, and the long-term predictive effect of baseline PSA levels is unclear, while the range of 0.1 to 1.0 ng/mL is still too broad. Future studies should assess the risk of PCa specifically based on the patient’s respective risk factors (PSA level, race, family history, age, etc.) and better develop PSA screening programs.