Prostate Cancer in Men with Serum PSA of

Abstract

With the introduction of prostate-specific antigen (PSA) screening two decades ago, early diagnosis and treatment of prostate cancer has become widespread. Largely based on an unproven notion that early detection may lead to reduction in cancer mortality, the policy of routinely administering a PSA test and digital rectal examination to men aged 50 yr has been adopted in many countries as part of the medical checkup. In 2001, approximately 75% of men in this age group in the United States reported that they had undergone PSA screening, and 54% reported receiving regular annual PSA tests [1]. Prospective, preferably population-based, randomized trials are needed to determine whether early detection of prostate cancer ultimately reduces cancer mortality rates. At the present time, two large-scale randomized trials are under way: the Prostate, Lung, Colon, and Ovarian (PLCO) Cancer Screening Trial in the United States and the European Randomized Study of Screening for Prostate Cancer (ERSSPC) in eight European countries. The first analysis of the central end point of these trials— cancer-related mortality—is not scheduled until 2008. Thus, to date, evidence is insufficient to support or discourage routine or opportunistic PSA screening for prostate cancer [2]. The primary goal of cancer screening is to identify the disease at a stage in its natural history when treatment can be implemented to prevent the onset of symptoms and, ultimately, death. Applying this tenet to prostate cancer is somewhat problematic