The goal of screening for prostate cancer is to reduce mortality from the disease.1,2 Two types of screening can be defined: population-based mass screening, in which all men in a defined (at-risk) population are offered an evaluation by the screening organisation, and opportunistic screening for individual patients, which is initiated by the patient and/or his physician.1
The recently published European Randomized Study of Screening for Prostate Cancer (ERSPC) demonstrated that screening reduced mortality at 9 years by 20%.3 However, the amplitude of the benefit remains quite low – for a healthy asymptomatic man, being screened will reduce his risk of dying from prostate cancer by 0.07%. In addition, the study found a high rate of overtreatment and estimated that 48 men must be treated for one death to be prevented. Therefore mass screening remains controversial and such programmes are not currently recommended by European guidelines.3
In contrast, within the European Association of Urology Guidelines it is suggested screening should be offered in the form of baseline prostate specific antigen (PSA) determination at age 40 years. Upon which the subsequent screening interval may then be based.1 For patients undergoing early screening, digital rectal examination (DRE) should also be considered (see diagnosis). In about 18% of all patients PCa is detected by a suspect DRE alone irrespective of the PSA level.1
References:
1. European Association of Urology. Guidelines on prostate cancer, 2010.
2. American Urological Association. Prostate-specific antigen best practice statement: 2009 update.
3. Schröder FH, Hugosson J, Roobol MJ, et al. Screening and prostate-cancer mortality in a randomized European study. N Engl J Med 2009;360:1320-8.