Prostate cancer. When to offer screening in the primary care setting

Prostate cancer is the second-leading cause of cancer death in American men over age 50. Even so, consensus is lacking on whom to screen, when to screen, and what to do if cancer is discovered. The two most commonly used screening methods are digital rectal examination and serum prostate-specific antigen (PSA). PSA misses 18 to 25% of prostate cancers and provides false-positive results some 60% of the time. PSA test refinements are improving its sensitivity and specificity and therefore the early, accurate detection of prostate cancer. Whether routine screening of all men is cost-effective remains controversial--especially for men age 75 and older--but the value of screening to the individual patient is the concern of the primary care physician.