Screening for prostate cancer

Over the past few decades it has become clear that prostate cancer is a serious health problem in elderly men. The population of most Western countries is ageing and the number of deaths from prostate cancer patients is increasing. The most promising way to deal with this problem seems to be through early detection of the disease, which can be accomplished through case finding and screening of the male population at risk. The basic purpose of screening for a given disease is to separate from a large group of apparently healthy individuals those who have a high probability of having the disease under study. These individuals may be given a diagnostic workup, and if the diagnosis is established they can be brought to treatment. The concept of prostate cancer screening, however, is an extensively debated issue. The limited knowledge of the natural history, uncertainties about the effectiveness of treatment in reducing mortality and the adverse effects of treatment lead to fear of overdiagnosis and subsequent overtreatment. Routine application of screening for prostate cancer should not take place before the results of multicentre prospective randomised studies demonstrate a reduction in prostate cancer mortality through screening of the male population.