Prostate cancer screening and prevention: "realities and hope"

Case finding and population screening for early prostate cancer are extensively debated issues. The increasing incidence and mortality of prostate cancer, although largely in older patients, suggests that some type of preventive measures should be undertaken to reverse this trend. The basic requirements for initiation of a population screening program were established by Wilson and Jungner in 1968. Based on available data, the following requirements are considered to be realities in this article: the importance of the health problem, the effectiveness of available treatment, the availability of the facilities, the identification of latent stages of the disease, the existence of effective screening methodology, and the acceptability of screening by the population to be screened. For choice of treatment and the stage of the tumor at the time of diagnosis, the data analysis is positive but caution is advised. Errors of commission and omission do occur in daily practice. The answers to the remaining four requirements are less clear. There is hope--but no certainty--that we are able to predict the natural history of the disease, that early treatment does reduce mortality, that treatment strategies avoid overlap, and that the cost of population screening has been appropriately calculated. The lack of a positive answer to these questions leads us to advise against general screening but to support definitively a randomized screening trial to provide answers in the next decade.