Prostate cancer screening: more harm than good?

The American Cancer Society and other national medical organizations emphasize the need for routine screening for prostate cancer in men over the age of 50. The serum prostate-specific antigen (PSA) assay is the test most commonly recommended for the purpose of screening. However, when PSA screening is examined critically from the standpoint of the principles of screening, evidence from prospective studies to support the routine use of PSA testing is lacking. Data suggest that screening often detects what may be indolent, nonaggressive prostate cancer. The treatment of such a cancer with radiation or radical prostatectomy can result in significant morbidity, including urinary incontinence and impotence, without a proven decrease in mortality. Evidence from randomized clinical trials in support of routine PSA screening is urgently needed.