Prostate cancer: epidemiology and screening

The 13th International Prostate Cancer Update provided an overview of diagnosis, treatment, and management strategies in prostate cancer. This article provides a summary of the reports presented during the epidemiology and screening session. Methods to improve early detection and treatment are being developed. Proposed refinements to prostate-specific antigen (PSA) testing include the use of age-specific PSA levels, PSA velocity, prostate volume-adjusted PSA densities, free-to-total PSA ratios, and complexed PSA. Optimal follow-up screening intervals for persons who elect PSA testing and are found to have initially normal levels have been proposed. Molecular oncology is becoming increasingly important in understanding the development and progression of prostate cancer as well as identifying new therapeutic targets for hormone-refractory disease. Nomograms that include PSA levels, histologic grade, and the extent of the tumor have been developed to optimize management decisions. Despite advances in early detection and treatment, controversy persists because of the lack of evidence demonstrating that they improve length and quality of life. Until results from randomized trials are completed, clinicians should provide patients with balanced information that incorporates the potential risks and benefits of screening and treatment and individual preferences for various outcomes.