Future of screening for prostate cancer

Few topics in medicine stir up as much controversy as prostate cancer screening. Prostate cancer is a highly prevalent, potentially lethal disease, making the enthusiasm of the public and health professionals for screening and treatment understandable.1 However, many screen detected cancers have a protracted and indolent natural course with no adverse effects for decades, and patients are at greater risk from the ensuing cascade of diagnostic imaging and unnecessary treatments than from the disease itself.

Current best evidence suggests that prostate specific antigen (PSA) testing provides only a small reduction in prostate cancer mortality and no reduction in all cause mortality, while at the same time exposing healthy individuals to the risk of overdiagnosis and overtreatment.2 Recent draft recommendations by the United States Preventive Services Task Force against population based screening (grade C), emphasise the importance of shared decision making between men and their healthcare providers but fall short of providing other actionable guidance.3 Although the results of the CAP …