title: 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 5alpha-reductase inhibitors in high-risk patients, and the continued development of urinary and genetic markers hold promise in this regard.
authors.affiliation: Washington University School of Medicine, Barnes-Jewish Hospital, Siteman Cancer Center, 4960 Children's Place, St Louis, MO 63110, USA.
authors.forename: Seth A
authors.initials: SA
authors.lastname: Strope
authors.forename: Gerald L
authors.initials: GL
authors.lastname: Andriole
mesh_terms: D005544:Forecasting; D006801:Humans; D008297:Male; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D016032:Randomized Controlled Trials as Topic
references.citation: J Clin Oncol. 2009 Sep 10;27(26):4300-5
references.pmid: 19636023
references.citation: Cancer. 2009 Sep 1;115(17):3879-86
references.pmid: 19517474
references.citation: Cancer Causes Control. 2008 Mar;19(2):175-81
references.pmid: 18027095
references.citation: CA Cancer J Clin. 2010 Mar-Apr;60(2):99-119
references.pmid: 20228384
references.citation: BMC Med. 2008 Feb 15;6:6
references.pmid: 18279502
references.citation: J Natl Cancer Inst. 2009 Mar 18;101(6):374-83
references.pmid: 19276453
references.citation: J Natl Cancer Inst. 2008 Aug 20;100(16):1144-54
references.pmid: 18695132
references.citation: Am J Prev Med. 2008 Feb;34(2):164-70
references.pmid: 18201648
references.citation: J Natl Cancer Inst. 2006 Aug 16;98(16):1128-33
references.pmid: 16912265
references.citation: J Natl Cancer Inst. 2009 Sep 16;101(18):1280-3
references.pmid: 19713548
references.citation: BJU Int. 2008 Dec;102(11):1524-30
references.pmid: 19035857
references.citation: J Natl Cancer Inst. 1998 Aug 19;90(16):1230-1
references.pmid: 9719085
references.citation: Nat Rev Urol. 2010 Feb;7(2):101-9
references.pmid: 20065953
references.citation: N Engl J Med. 2009 Mar 26;360(13):1310-9
references.pmid: 19297565
references.citation: Int J Cancer. 2010 May 15;126(10):2387-93
references.pmid: 19739124
references.citation: J Natl Cancer Inst. 2010 Mar 3;102(5):288-9
references.pmid: 20142583
references.citation: Urology. 1998 Sep;52(3):444-8; discussion 448-9
references.pmid: 9730458
references.citation: Urology. 2006 Feb;67(2):316-20
references.pmid: 16442597
references.citation: Cancer Causes Control. 2007 Nov;18(9):931-7
references.pmid: 17641982
references.citation: Lancet Oncol. 2008 May;9(5):445-52
references.pmid: 18424233
references.citation: N Engl J Med. 2009 Mar 26;360(13):1320-8
references.pmid: 19297566
references.citation: JAMA. 2005 May 4;293(17):2095-101
references.pmid: 15870412
references.citation: Arch Intern Med. 2006 Jan 9;166(1):7-8
references.pmid: 16401804
references.citation: J Natl Cancer Inst. 2009 Oct 7;101(19):1325-9
references.pmid: 19720969
references.citation: J Natl Cancer Inst. 2010 Mar 3;102(5):352-5
references.pmid: 20142584
references.citation: Am J Epidemiol. 2004 Dec 1;160(11):1059-69
references.pmid: 15561985
references.citation: CA Cancer J Clin. 2009 Jul-Aug;59(4):225-49
references.pmid: 19474385
references.citation: N Engl J Med. 2002 Sep 12;347(11):781-9
references.pmid: 12226148
references.citation: N Engl J Med. 2008 Feb 28;358(9):910-9
references.pmid: 18199855
references.citation: Arch Intern Med. 2006 Jan 9;166(1):38-43
references.pmid: 16401808
references.citation: J Natl Cancer Inst. 2003 Jun 18;95(12):868-78
references.pmid: 12813170
references.citation: J Clin Oncol. 2007 Feb 1;25(4):431-6
references.pmid: 17264339
references.citation: J Urol. 2005 Mar;173(3):746-50; discussion 750-1
references.pmid: 15711261
references.citation: Eur Urol. 2009 Aug;56(2):270-1
references.pmid: 19481336
references.citation: JAMA. 2005 Jul 6;294(1):66-70
references.pmid: 15998892
references.citation: Med Decis Making. 2008 May-Jun;28(3):323-31
references.pmid: 18319508
references.citation: BJU Int. 2009 Dec;104(11):1592-8
references.pmid: 19549125
references.citation: N Engl J Med. 2010 Apr 1;362(13):1192-202
references.pmid: 20357281
references.citation: Urology. 2001 Sep;58(3):417-24
references.pmid: 11549491
references.citation: Lancet. 2009 Jan 24;373(9660):301-8
references.pmid: 19091394
references.citation: Lancet Oncol. 2008 May;9(5):407-9
references.pmid: 18452850
references.citation: J Urol. 2003 Oct;170(4 Pt 1):1189-93
references.pmid: 14501722
references.citation: J Urol. 2005 Aug;174(2):495-9; discussion 499
references.pmid: 16006879
references.citation: N Engl J Med. 2008 Feb 28;358(9):961-3
references.pmid: 18199856
references.citation: Lancet. 2000 May 20;355(9217):1788-9
references.pmid: 10832832
references.citation: BMJ. 2002 Oct 5;325(7367):740
references.pmid: 12364300
references.citation: J Natl Cancer Inst. 2005 Sep 7;97(17):1248-53
references.pmid: 16145045
references.citation: Urology. 2001 Sep;58(3):411-6
references.pmid: 11549490
references.citation: Control Clin Trials. 2000 Dec;21(6 Suppl):273S-309S
references.pmid: 11189684
references.citation: J Urol. 2011 Jan;185(1):126-31
references.pmid: 21074214
references.citation: Int J Urol. 2008 Sep;15(9):763-8
references.pmid: 18786203
references.citation: N Engl J Med. 2003 Jul 17;349(3):215-24
references.pmid: 12824459
references.citation: BJU Int. 2008 Apr;101(7):809-16
references.pmid: 18321314
references.citation: Ann Intern Med. 2008 Aug 5;149(3):192-9
references.pmid: 18678846
references.citation: J Natl Cancer Inst. 2007 Sep 5;99(17):1296-303
references.pmid: 17728218
references.citation: J Natl Cancer Inst. 2007 Dec 19;99(24):1881-7
references.pmid: 18073376