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Prostate cancer remains the most common non-cutaneous malignancy in the Western world and is the second leading cause of cancer death in males.1 The lifetime risk of developing and dying from prostate cancer rises substantially among men after the age of 50 years and a twofold greater risk exists among African–American men. Along with age and race, having a family history of prostate cancer is also a well-established risk factor. The incidence of prostate cancer has increased dramatically within the past decade, primarily due to the utilisation of serum prostate specific antigen (PSA) as a screening test that has resulted in earlier diagnosis.1 Prostate cancer screening means the examination of asymptomatic people in order to classify them according to whether they are likely or unlikely to have prostate cancer. Apart from PSA, screening includes digital rectal examination, trans-rectal ultrasound and biopsies on indication.
PROBLEMS WITH ROUTINE SCREENING
Several problems have beset the widespread acceptance of screening.2 Firstly, the correct protocol has yet to be established.2 Digital rectal examination as a screening tool relies heavily on the experience of the examiner and if it is used alone, one third of patients diagnosed with prostate cancer will have incurable disease. Transrectal ultrasound, when used alone, has low positive and negative predictive values. Secondly, one of the concerns about routine screening for prostate cancer is that either: (1) it may detect patients who have incurable prostate cancer that has spread beyond the prostate capsule; or (2) small tumours that will be clinically unimportant during the lifetime of the patient may be discovered, the resulting treatment of which may cause appreciable morbidity.2 3
Routine screening for prostate cancer is controversial because of frequent false-positive results, the potential for slow, non-life threatening growth of untreated cancer, the uncertainty about whether treatment can extend life, …