Screening for prostate cancer: an update.

OBJECTIVES

To review evidence regarding the potential introduction of prostate cancer screening programmes and highlight issues pertinent to the management of screen-detected prostate cancer.

METHODS

Screening for prostate cancer is a controversial health care issue in general and urological practice. A PubMed database search was performed, followed by a systematic review of the literature, to examine the evidence base underlying prostate cancer screening.

RESULTS

A prostate cancer screening programme should satisfy several key postulates prior to its introduction. To date, several of these postulates have not been satisfied, and the evidence available for prostate cancer screening is currently insufficient to warrant its introduction as a public health policy. The natural history of screen-detected prostate cancer remains poorly understood, and recent evidence suggests that a screening programme may detect a large number of men with indolent disease who may be subsequently overtreated. Several randomised clinical trials are currently in progress and it is hoped that they will provide robust evidence to inform future practice.

CONCLUSIONS

National systematic prostate cancer screening programmes outside randomised clinical trial settings have not been implemented to date owing to lack of robust evidence that such programmes would improve survival and/or quality of life in men with screen-detected disease. Forthcoming results of clinical trials and the application of appropriate risk stratification to prevent overtreatment of indolent prostate cancer are likely to change practice in coming years.