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Prostate Cancer: Screening and Early Detection

from Cancer Control: Journal of the Moffitt Cancer Center

Michael S. Cookson, MD, Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN

Abstract and Introduction

AbstractBackground: Despite more than a decade of prostate-specific antigen (PSA)-based screening, the proven impact of screening on mortality due to prostate cancer continues to be controversial.
Methods: A literature review of issues pertaining to the epidemiology, screening, early detection, and mortality as they relate to prostate cancer was conducted. Included in the review are PSA refinements, controversies of screening, and organization guidelines. Finally, recent reports of mortality rates in the post-PSA era are presented for discussion.
Results: Prostate cancer mortality rates have begun to decline for the first time since statistics have been recorded. The recent decline in age-adjusted mortality rates from prostate cancer is significant, and this decline appears to be earlier than would have been predicted. This finding, coupled with the dramatic decline in metastatic disease, implies that PSA-based screening may be responsible for a significant portion of this improvement in mortality.
Conclusions: The cost of prostate cancer screening appears to be acceptable. Randomized studies of PSA-based screening are currently ongoing, although the results may not be available for a decade. Currently, the best evidence is derived from population-based studies that appear to show a benefit to prostate cancer screening. From the Department of Urologic Surgery at the Vanderbilt University School of Medicine, Nashville, Tennessee.

IntroductionProstate cancer screening remains a source of major controversy in the United States.[1] The potential benefits and harms continue to be debated among health professionals despite more than a decade of prostate-specific antigen (PSA)-based screening and early detection. Among the concerns are the possibility that screening and early detection will not impact on the deaths related to prostate cancer, the potential for treatment-related morbidity and mortality, and the cost of screening, diagnosis, and treatment to society. This article discusses these concerns and highlights the latest developments in prostate cancer screening and early detection.