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How should PSA screening efforts be focused to prevent underdiagnosis and overdiagnosis of prostate cancer?

Nature Clinical Practice Urology volume 5, pages 172–173 (2008)Cite this article

Identification of individuals who are at high risk of developing prostate cancer, and those who are not, is a difficult issue to address. Although the specific causes of prostate cancer initiation and progression are not yet known, considerable evidence indicates that both genetic and environmental factors have a role in the origin and evolution of this disease. Classic and molecular epidemiology studies have identified a number of potential risk factors associated with the development of prostate cancer. For example, a number of case–control studies have demonstrated familial clustering of prostate cancer: in the early nineties, Cater and co-workers1 concluded that men who have one first-degree relative with prostate cancer have a twofold increased risk of developing prostate cancer, while men with two or three affected first-degree relatives have a fivefold and 11-fold increased risk, respectively. Other possible hereditary risk factors include genetic polymorphisms in the genes encoding 5α reductase type 2 and the androgen receptor.

The most convincing evidence supporting the role of the environment in the development of prostate cancer comes from migration studies, which have shown an increased incidence of prostate cancer in first-generation immigrants from Japan and China compared with native populations.2 An important limitation of these migration studies is that even though they show that lifestyle affects the development of prostate cancer, we do not know the specific lifestyle details that could be modified to reduce the risk of this disease. How many lycopene, selenium and vitamin E tablets should be taken to prevent or minimize the risk of developing prostate cancer? And how does smoking, dietary fat, obesity, alcohol consumption and sexual activity, which exposes the prostate to infectious agents, influence the risk of developing this disease? Although we know that associations exist between these factors and the risk of developing prostate cancer, no parameters have been defined that can be used in clinical practice.

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Authors and Affiliations

  1. AE Pelzer is an Assistant Professor of Urology at the Department of Urology, Managing Medical Director of the Department of Urology, University of Tübingen, Germany, and W Horninger is an Associate Professor of Urology, and Director of the European Prostate Center Innsbruck, Innsbruck Medical University, Innsbruck, Austria.,

    Alexandre E Pelzer & Wolfgang Horninger

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  1. Alexandre E Pelzer
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  2. Wolfgang Horninger
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Correspondence to Alexandre E Pelzer.

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The authors declare no competing financial interests.

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Pelzer, A., Horninger, W. How should PSA screening efforts be focused to prevent underdiagnosis and overdiagnosis of prostate cancer?. Nat Rev Urol 5, 172–173 (2008). https://doi.org/10.1038/ncpuro1051

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