Review – Prostate CancerScreening for Prostate Cancer: An Update
Introduction
Screening for prostate cancer is a controversial issue in health care in general and urological practice in particular [1]. The merits of introducing national prostate cancer screening programmes in Europe are currently being debated. At present, the evidence to support the implementation of national prostate cancer screening programmes is inadequate. These programmes have therefore not been introduced in a systematic fashion outside randomised clinical trial settings. Whilst policy appears uniform in Western countries, guidance differs. In the United States, guidance currently favours the principle of screening for prostate cancer. The American Cancer Society recommends screening for all men aged at least 50 yr, although it acknowledges that men should be educated about issues regarding early detection and prostate cancer treatment, thereby aiding full participation in decision making [2]. The American Urological Association recommends that healthy men over the age of 50 should consider prostate cancer screening with a digital rectal examination (DRE) and serum prostate-specific antigen (PSA) test [3]. We herein review the public health issues pertinent to introducing a prostate cancer screening programme whilst acknowledging that individual men and their physician may have a different perspective on PSA testing.
Section snippets
Principles of screening
“Screening” identifies preclinical and asymptomatic cases of a disease in a population at risk using a suitable test, rather than making a diagnosis based on a patient's presentation at a later stage with symptoms and signs. The natural history of cancer suggests that a malignancy or precursor lesion may be detectable in advance of the appearance of symptoms and signs during a “screen-detectable” preclinical period [4]. Population-based screening programmes aim to reduce cancer morbidity and
Future developments
Future developments are likely to impact on the potential introduction of prostate cancer screening programmes. Firstly, the results of the large RCTs currently in progress will have a major influence on the merits of introducing systematic prostate cancer screening programmes, and on the effectiveness of available treatment options. Secondly, there is an urgent need to develop a combination of methods for accurate risk stratification to target therapies more appropriately to those patients
Conclusions
In our era of “evidence-based medicine” and in the absence of sufficient data from RCTs, it is currently inappropriate to introduce mass screening for prostate cancer. Public health policy should follow the acquisition of adequate evidence to drive clinical practice, rather than yield to mounting pressures from the general public, the media, and some professional medical organisations to introduce screening outside the context of well-conducted research. Future advances will be guided by the
Conflicts of interest
The authors have nothing to disclose.
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