Prostate-specific antigen-based screening for prostate cancer: evidence, controversies and future perspectives

The most recent epidemiological survey revealed that the mortality rate for prostate cancer in Japan has increased and has been getting very close to that in the USA, where it has decreased since 1992. The low exposure rate of prostate-specific antigen (PSA) screening in Japan and the high exposure rate of PSA screening in the USA may result in completely deferent trends in the mortality rate of prostate cancer between the two countries. The Japanese Urological Association recommends PSA-based screening for men at risk of prostate cancer at age 50 years or older in general and 45 years or older in men with a family history of prostate cancer within first generation relatives. The fact sheet on screening for prostate cancer should indicate the most recent reliable clinical research on screening for prostate cancer and its demerits including false-negative and false-positive PSA test results and prostate biopsy, overdetection and overtreatment. However, it should be explained to the public that the demerits for PSA screening will be clarified step by step during screening, and in general, men having more information on screening results (PSA level, pathological findings of biopsy specimens, clinical stage, etc.) can understand their current situation better than those having no information on screening results, including PSA levels.