Screening for Prostate Cancer

Proponents of widespread screening argue that current screening protocols result in detection of medically important prostate cancers while they are still organ-confined and curable.5,7 To date, however, screening has not been proven to reduce morbidity and mortality.8 Critics of widespread screening therefore contend that the financial, emotional, and physical burdens of screening and subsequent diagnostic and therapeutic interventions may outweigh presumed benefits from screening.3 Given these conflicting viewpoints, it is not surprising that screening recommendations issued by various professional organizations have been highly variable and even contradictory. The American Cancer Society and the American Urological Association are in agreement in recommending that annual prostate cancer screening with digital rectal examinations (DRE) and PSA levels should be offered to all men starting at age 50 and for younger men who are at increased risk for prostate cancer.9 This protocol was approved by the Food and Drug Administration (FDA) in 1997.10 Recent recommendations from the American College of Physicians, however, do not endorse routine screening of all men but instead advocate an approach whereby physicians outline the potential benefits and known harms of screening, diagnosis, and treatment, discuss the patient's concerns, and then allow the screening decision to be made on an individual basis.11 The United States Preventive Services Task Force does not currently recommend any routine screening for prostate cancer.9

Although disagreement on its appropriate use persists, screening for prostate cancer is widespread in the United States. Prostate Cancer Awareness Week, which was instituted in 1989, is now the largest cancer screening program in the nation and has attracted more than 3 million participants.12 In addition, efforts are well underway to recruit over 300,000 men to participate in randomized, controlled trials in both the United States and Europe that may determine whether screening for prostate cancer improves mortality. The United States component of this international group, the National Cancer Institute's Prostate, Lung, Colorectal, Ovarian (PLCO) screening trial, has already enrolled over 50,000 men.13 Given the highly promising data on screening currently available as well as the enormous public interest, it is clear that screening programs will remain prevalent for years to come.

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