PROSTATE-CANCER - ENTHUSIASM FOR SCREENING

Recent articles in the Journal have suggested that screening for prostate cancer is inappropriate and that intervention for localised disease, especially by means of radical prostatectomy, does more harm than good.(1-3) I question these viewpoints and present the case for screening. Screening for prostate cancer is recommended by the American Cancer Society(4) and the American Urological Association,(5) but not by the Australian Cancer Society,(6) the Urological Society of Australasia,(1) or the Royal Australian College of General Practitioners.(6) The attitudes of the latter organisations are based primarily on the fact that there is no current proof that screening will result in decreased numbers of deaths from prostate cancer. Studies are under way, but these will take at least 10-15 years for final analysis. The key question then is: how should we advise our patients today? The naysayers believe that one should wait for the studies to be completed before advising patients. On the other hand, one can try to predict, from the available information, what conclusions will eventually be reached. The recommendations for screening for breast cancer by mammography followed 10-15 years of study which showed that it reduced the number of deaths from breast cancer.(7,8) For screening to be considered useful, three main criteria need to be satisfied: Is the disease a major health problem? Is there effective treatment? Are the tests acceptable, safe, reproducible and cost effective? Does prostate cancer screening meet these criteria now? I think yes and my reasons are as follows.