ABSTRACT
Prostate cancer is a significant cause of morbidity and mortality in the USA and Europe. In the USA alone, an estimated 189 000 new prostate cancer cases will be diagnosed in 2002, with 30 200 deaths attributable to the disease1. The natural aging of the population, combined with the continued and widespread use of improved diagnostic tests such as that for serum prostate-specific antigen (PSA), is resulting in an increase in the numbers of men diagnosed with localized prostate cancer. Screening to identify organ-confined prostate cancer has provoked much public and scientific attention, and there is intense debate about its role in improving men’s health. While there are strong advocates of screening, the findings from most reviews of the scientific evidence conclude that it is insufficient, at present, to recommend routine population screening because of the lack of evidence that this would improve survival and the quality of men’s lives. Particular concerns in these reviews relate to the lack of knowledge about the natural history of screen-detected disease, and the lack of evidence about the effectiveness of treatments. In particular, to date, no survival advantage has been shown in screen-detected cases for any of the major treatments (radical prostatectomy, radical radiotherapy including brachytherapy and ‘watchful waiting’), and each can result in damaging iatrogenic complications and outcomes, including various levels of incontinence and impotence for radical interventions and anxiety relating to the presence of cancer in ‘watchful waiting’.
