Prostate cancer screening: issues and controversies

Prostate cancer is the second leading cause of cancer death among men. Because it has been thought that identifying the disease earlier leads to better outcomes, there has been a great deal of interest in screening for the disease. Since the late 1980s, testing for elevated prostate-specific antigen (PSA) levels in blood has been the most prominent screening tool. Despite widespread adoption of PSA testing, however, it remains controversial. It has been shown that elevated PSA levels do not always indicate cancer and low PSA levels do not ensure that cancer is absent. In addition, there has been conflicting evidence about whether definitive treatment of prostate cancer is always indicated. As a result of the conflicting evidence on the efficacy of PSA testing as a screening tool and the necessity of treatment of prostate cancer in all cases, national organizations have issued various guidelines for screening. Thus, the decision to screen or not to screen remains in the court of the individual patient and physician. This article reviews the current thinking about PSA testing, highlights relevant research findings, and discusses possible changes to screening and treatment that may appear in the near future.