Screening for Prostate Cancer
In 2010, 217,730 men will have been diagnosed with prostate cancer (PCa) in the United States of America (USA), and around 32,730 will have died from the disease [1]. Depending on the extent of prostate-specific antigen (PSA) testing, similar ratios of in
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David R. Yates and John B. Anderson
Introduction In 2010, 217,730 men will have been diagnosed with prostate cancer (PCa) in the United States of America (USA), and around 32,730 will have died from the disease [1]. Depending on the extent of prostate-specific antigen (PSA) testing, similar ratios of incidence and mortality will be seen throughout Europe; PCa is the second commonest cause of death from cancer in men in the UK, and in the USA, it is estimated that a man aged 40 years has a 16 % chance of being diagnosed and a 3 % lifetime chance of dying from PCa [2]. Once diagnosed, the chance of a man dying from his cancer rather than other causes depends not only on the biological aggressiveness of the tumor and the age and comorbidity of the individual in question but crucially on the stage of the disease at diagnosis and, by definition, how early it has been detected. Screening for disease to allow early detection is now an integral part of modern medicine, and screening for breast, cervical, and colorectal cancer is now standard practice in some countries. Although PCa is an equally important health problem, PSA testing to screen for the disease, allowing earlier detection and thereby reducing the chance of a man dying from PCa, remains controversial with the medical community divided on whether this approach causes more harm than good.
The Principles of Screening Definitions Cancer screening aims to identify preclinical and asymptomatic cases of a disease in a population at risk rather than waiting to make a diagnosis once a patient presents at a later stage with
D.R. Yates, MBChB, M.D., FRCS (Urol) (*) • J.B. Anderson Department of Urology, Royal Hallamshire Hospital, Glossop Road, Sheffield, South Yorkshire S10 2RX, UK e-mail: [email protected]; [email protected] A. Tewari (ed.), Prostate Cancer: A Comprehensive Perspective, DOI 10.1007/978-1-4471-2864-9_27, © Springer-Verlag London 2013
signs and symptoms. The rationale behind screening is simple: to detect cancer at an early stage when it is still curable. Population-based screening programs aim to reduce cancer mortality and morbidity by detecting cancer at an early stage, on the assumption that earlier diagnosis and treatment will potentially improve prognosis and survival. The criteria against which any screening program is designed or critically assessed originate from the 1968 World Health Organization (WHO) document written by Wilson and Jungner [3], while the United Kingdom National Screening Committee has recently produced comprehensive standards to assess the efficacy and effectiveness of any screening program (www.screening.nhs.uk). Screening for cancer may take place in a variety of ways ranging from mass screening of a general population, through more selective screening by targeting “high-risk” populations, opportunistic screening which is incorporated as part of a medical consultation for other reasons, and simple case finding.
Screening for Prostate Cancer General As with any cancer screening program, the primary goal o
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