Screening for Prostate Cancer

Abstract

The benefits of one-time or repeated screening with either a digital rectal examination and/or testing for prostate-specific antigen (PSA), followed by some form of aggressive therapy has not yet been proved. Both the digital rectal examination and serum PSA measurement have both false-positive and false-negative results. Testing for serum PSA will likely lead to additional invasive testing, including a transrectal ultrasound and biopsy. Treatment with radical prostatectomy, radiation therapy, brachytherapy, or some combination of these treatments is necessary to realize any benefit from the discovery of prostate cancer by screening tests. Aggressive treatments for prostate cancer are associated with several risks, including incontinence, bowel and bladder irritability, impotence, and a very small, but definite risk of early death. Early detection and treatment of prostate cancer may avert future cancer associated illness and death from prostate cancer. Men most likely to benefit from screening and treatment are men in their sixth and seventh decades as compared with men older than 70 yr of age. Routine screening for prostate cancer without a discussion of these issues is inappropriate.