Screening for prostate cancer remains controversial

Abstract

Two long awaited randomised trials of PSA screening have reported this year. However, as Jennifer Stark and colleagues explain, the results are unlikely to end the controversy over the benefits and harms of testing The introduction of prostate specific antigen (PSA) testing as a screening tool has transformed the clinical landscape of prostate cancer. Screening allows prostate cancer to be diagnosed many years earlier, offering hope that a newly detected cancer is still localised to the prostate when treatment is curative. However, screening has also led to considerable false positive results and extensive overdiagnosis of disease that would not otherwise emerge clinically. We summarise current screening guidelines and review the evidence of benefit and harm of PSA testing. The US Food and Drug Administration approved PSA testing to monitor progression of cancer among men with prostate cancer in 1986 and for early detection of prostate cancer in 1994. Nevertheless, many agencies in the US and Europe do not recommend routine prostate cancer screening (box 1). The European Association of Urology, for instance, states that “Current published data are insufficient to recommend the adoption of population screening for prostate cancer as a public health policy due to the large overtreatment effect.” The notable exception is the American Urological Association,1 which updated its guidelines after the publication of the results of two recent randomised trials2 3 of prostate cancer screening, and now recommends annual screening for men aged 40 and older who have a life expectancy of at least 10 years. #### Box 1 International recommendations on screening for prostate cancer