[Future perspectives on screening for prostate cancer - an experienced Urologist's viewpoint]

Recently, large prospective randomized controlled trials, the European Randomized Study of Screening for Prostate Cancer (ERSPC)and the Göteborg study, revealed that prostate specific antigen(PSA)-based screening can reduce mortality due to prostate cancer. In the Göteborg study, the reduction in mortality in the screening group during the median 14 years of follow-up was very high at 44%, based on intention-to-screen analysis. The merits of introducing PSA-based screening could be mortality reduction and prevention of progression to metastatic disease, which could decrease patient quality of life (QOL). Furthermore, the impact of screening for prostate cancer on mortality reduction was not inferior to that of the other population- based cancer screening program conducted in Japan, at the least. Therefore, PSA-based screening should be undertaken both as part of population-based screening and as part of opportunistic screening in Japan. However, as disadvantages, some participants in the screening program might be at risk of over detection and overtreatment. Therefore, providing a fact sheet for prostate cancer screening and an optimal screening system with more accurate detection methods, minimally invasive treatment, and an active surveillance strategy, which minimizes over detection, overtreatment, and a compromise in QOL due to treatment, would be very important issues to address for PSA screening. Although the merits of screening for prostate cancer would increase and the disadvantages would decrease in future, with the progress in diagnostic modalities and treatment strategies, it is crucial that PSA-based screening be conducted in accordance with well-balanced guidelines published by the Japanese Urological Association.