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Prostate cancer screening: current status and future perspectives

Abstract

With the publication of the long-term results of two randomized screening trials and updates to screening guidelines from many organizations, the past 2 years have been eventful in the field of prostate cancer screening. Both the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial—which failed to identify a benefit of screening in a community setting—and the European Randomized Study of Screening for Prostate Cancer—which showed a modest benefit to screening in a clinical trial setting—have sought to address the role of screening in reducing mortality from prostate cancer. Epidemiologic evidence supports the role of PSA screening in the stage and grade migration of prostate cancer, but to date the evidence for its role in changing mortality patterns is more equivocal. As a result, little support exists at present among urologic and cancer prevention organizations for population-based PSA screening. Particularly in the USA, where PSA screening has been relatively widespread, reductions in prostate-cancer-specific mortality are likely to be in part related to improvements in treatment, rather than solely to PSA screening. The substantial risk of overdiagnosis and overtreatment of latent prostate cancer means that methods to increase the specificity of prostate cancer screening, and particularly its ability to identify high-risk disease, are essential. Strategies such as the use of 5α-reductase inhibitors in high-risk patients, and the continued development of urinary and genetic markers hold promise in this regard.

Key Points

  • Epidemiologic evidence both supports and questions the effectiveness of PSA screening in reducing prostate cancer mortality

  • Overall, evidence supports the role of PSA screening in the observed stage and grade migration of prostate cancer

  • Little support exists among urologic and cancer prevention organizations for population-based PSA screening

  • Randomized trials (ERSPC and PLCO) have not resolved the controversies regarding PSA screening

  • Strategies to improve the performance of PSA testing and to better define aggressive disease are needed

  • Such strategies include the ongoing development of urinary markers, use of 5α-reductase inhibitors, and continued exploration of markers of aggressive disease

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Contributions

S. A. Strope and G. L. Andriole researched data for the article and made substantial contributions to discussion of content. S. A. Strope was involved in writing the article. S. A. Strope and G. L. Andriole took part in review/editing of the manuscript before submission.

Corresponding author

Correspondence to Gerald L. Andriole.

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Competing interests

G. L. Andriole declares that he has acted as a consultant for Gen-Probe, GlaxoSmithKline and Onconome, and has received speakers bureau honoraria from GlaxoSmithKline. S. A. Strope declares no competing interests.

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Strope, S., Andriole, G. Prostate cancer screening: current status and future perspectives. Nat Rev Urol 7, 487–493 (2010). https://doi.org/10.1038/nrurol.2010.120

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