[Screening for prostate cancer: present status and future perspectives].

In Japan, about three fourth municiparities and 90% human dry dock (a thorough medical checkup) institutions provide a prostate specific antigen (PSA) testing as a screening tool for early detection of prostate cancer. However, the exposure of screening for prostate cancer is very low compared to developed Western countries. The merits of introducing PSA-based screening could be cause-specific mortality reduction and prevention of developing metastatic disease, which was recently confirmed by prospective randomized controlled trials. On the other hand, some men participating in the screening program may be of drawbacks in terms of overdetection and overtreatment. Therefore, providing a fact sheet on screening for prostate cancer and also providing an optimal screening system including more accurate cancer detection, minimally invasive treatment and active surveillance strategy, which can reduce overdetection, overtreatment, and loss of QOL due to treatment, would be very important. The merits of PSA screening will increase and the drawbacks will decrease in the future due to progress in the diagnostic modalities and treatment strategies. At present, a baseline consensus is to conduct PSA-based screening according to well-balanced guidelines published by the Japanese Urological Association.