[Prostate cancer screening and early diagnosis]

Prostate cancer is the first cancer by incidence in men. However, the mortality rate is only around 15% of the new cases. There is a great heterogeneity of prognosis based on stage serum PSA and pathological prognostic score. The disease occurs in elderly patients (34% are older than 75 years). Patients' population life expectancy and individual chance of surviving is heterogeneous due to very different health status. Therefore decision must take into account both disease severity and health status. This decision making strategy is also true for screening and early diagnosis. To date there is no definite conclusion from randomized trials which support the indication of mass screening. The current recommendation is an individual early diagnosis procedure based on the measure of serum PSA level and Digital Rectal Examination. This procedure may only be proposed after an evaluation of person's health status and full information on consequences of such a procedure.