Prostate cancer screening: clinical applications and challenges

Prostate cancer is a serious illness warranting appropriate screening measures. However, current screening tests that include prostate-specific antigen and digital rectal examination must be proven to save lives to be considered truly legitimate and appropriate public health tools. Even though these tests are associated with the diagnosis of disease, important questions remain as to how well these tests identify all disease and whether screening leads to interventions that save lives. Prostate cancer is undoubtedly a killer, yet there appear to be large numbers of detectable prostate cancers that are of little threat to life. Some men with this grade of cancer receive curative treatment, even though their disease does not require treatment. Some studies suggest that more than three of four men with screen-detected localized disease may not need treatment. One of the great challenges of cancer communications is how to convey the hope of prostate cancer screening while adequately acknowledging the boundaries of our knowledge. The current absence of an appropriate informed consent tool points to the necessity to develop an easy to understand informed consent that allows men to evaluate screening decisions with a clear understanding of what is known, what is not known, and what is believed to be true about prostate cancer screening. (C) 2004 Elsevier Inc. All rights reserved.