Controversies in the early detection of prostate cancer.

Fundamental issues about early detection of prostate cancer are unresolved. There is controversy over the need for early detection of prostate cancer, based on a relatively small number of lifeyears lost to prostate cancer when compared with other types of cancers. Earlier detection of prostate cancer is possible with PSA-driven strategies based on evidence that there is an interval of probably several years when the PSA is abnormal but the prostate cancer is still in the curative state. Earlier detection may only be advisable in men with risk for premature death from prostate cancer, i.e., younger men. Immediate problems in early detection of prostate cancer include, 1) An apparent indiscriminate use of PSA in all age groups; 2) Probable over treatment in some older patients; and 3) Morbidity from currently available therapies. Physician education about the use of PSA can be accomplished now. More precise characterization of the morbidity of treatment is needed; efforts to improve the quality of surgery, radiation therapy, or alternative treatments are warranted. A marvelous opportunity and challenge are presented in a disease that will become an increasingly important health care issue in our society.