Public health perspective: the health policy implications of screening for prostate cancer

The appropriateness of adopting a new screening policy depends on the burden of suffering from the disease, and on the effectiveness, potential harms and costs of screening. Prostate cancer clearly satisfies the first requirement but the relationship among its benefits, harms and costs is uncertain due to lack of data. Available screening tests (for example prostate specific antigen) can detect early stage disease but there is no evidence that clinical outcomes are improved by early detection. The potential harms of screening 28 million men older than 50 years include unnecessary interventions for thousands of men without disease or with clinically insignificant cancer. The billions of dollars required for this effort could displace resources away from health care services of proved benefit. Ongoing clinical trials are expected to provide needed data. In the meantime, public policy should emphasize preventive services of proved effectiveness. Patients should be informed of what is known and not known about the potential benefits and harms of prostate cancer detection before undergoing screening.