Screening of Prostate Cancer

Abstract

In this chapter we aim to give insight in the burden of prostate cancer and the effects of early detection and treatments using ample available data from cancer registries and (randomized) clinical trials. Prostate cancer is the leading cancer type in men, and it occurs mainly at age 60–80 remaining asymptomatic during lifetime in many cases. The impact of a disease determines the need and extent of screening. Large-scale population-based prostate cancer screening trials mainly aimed to demonstrate a reduction in disease-specific mortality. After two decades it became clear that disease-specific mortality could be reduced, but at considerable harms including over diagnosis and related overtreatment. Interpretation of trial data is however hampered by, e.g., prostate-specific antigen (PSA) contamination of the control group and the continuous development of new diagnostic tools and treatment options. Nowadays, prostate cancer morbidity and quality of life are at least equally important as survival. Diagnostic strategies in prostate cancer screening protocols are now directed at trying to detect higher-risk prostate cancers in a really early phase and trying to avoid detection of low-volume, low-grade cancers. The ideal test does not (yet) exist meaning that clinically insignificant tumors will still be diagnosed and significant tumors can be missed. Until more advanced markers and diagnostic tools, less invasive treatments, and better active surveillance strategies combined into an individually tailored algorithm demonstrate a substantially better cost-effective impact, the decision whether or not to screen remains a shared decision between men and their physicians.