ABSTRACT

Major efforts are currently being made to improve the outcome of patients with prostate cancer by investigating the value of early detection of the disease. As is known from screening efforts directed at two other high-incidence cancers, i.e. those of the breast and lung, screening for malignancy can have serious negative side-effects. For instance, cancers thought to have a silent or latent natural course of disease may be detected, which are believed never to progress clinically. Obviously, the detection of these cancers will not lead to a reduction of disease-related mortality. On the other hand, cancers that would have soon progressed clinically may be detected by early screening, and such detection programs will only give the host the earlier knowledge of having an incurable, lethal disease. In previous reports we have already attempted to define the ‘window of opportunity’ in population-based screening for prostate cancer, i.e. for those men in whom the application of screening tests, subsequent diagnostics and early treatment is believed to be truly beneficial1. In this particular study, the tumor characteristics of those who underwent radical prostatectomy were compared with the recurrence of prostatespecific antigen (PSA) after surgery. Unfortunately, the median follow-up was short (33.0 months) and the number of events was small. Furthermore, as PSA relapse is known to be an intermediate end-point after surgery, and in itself does not predict the occurrence of clinically progressing disease, firm conclusions on the prognostic value of radical prostatectomy tumor features could not be drawn. As time passes, and the European screening study continues its course towards completion, the exact (tumor) characteristics of those who may be cured definitively by radical prostatectomy, and alternatively of those who may not be helped by this operative procedure, may be defined and outlined

more precisely. Still, we must understand that the precise window of opportunity in screening for prostate cancer can only be determined when large-scale randomized clinical trials have been completed and properly analyzed. Using the prostate cancer death rate as a definitive outcome measure of screening, the exact ‘window of curability’ may be defined in retrospection.