Epilogue: different approaches for prostate cancer screening in the EU?
Individual approaches to prostate cancer screening in European countries could occur as a result of individual decision taking, public health policies or the relevance of the prostate cancer problem determined by incidence and mortality in individual countries.


METHODS
An attempt is made to analyse current literature with respect to factors that could influence the individual or country-wide preference for or against the use of PSA driven screening. To obtain background information the incidence and mortality of prostate cancer in the EU countries participating in the ERSPC study, as well as the results of a recent join-point analysis of prostate cancer mortality for the same countries are reviewed. In addition, the question whether geographic differences in incidence and mortality could influence the value of screening tests in the different countries is evaluated.


RESULTS
Our literature review shows large regional differences in incidence and mortality of prostate. Proportions of men testing positive with PSA values ⩾4.0 ng/ml and PPVs do not reflect these regional differences. Also, regional differences are not in line with negative outcomes for any ERSPC center in an exploratory analysis of prostate cancer mortality. In all centers a decrease of prostate cancer mortality at various degrees was seen. Differences in attitude may be visible in the join-point regression analysis which shows differences in mortality trends for some countries. Detection of T1c cancers in the control group is a measure of opportunistic screening (limitations addressed in the text). The differences reported may best reflect regional decision patterns. As far as the validity of PSA driven testing in countries with a different incidence and mortality is concerned, it seems that neither the levels nor the predictive value of PSA is influenced by such differences.


CONCLUSIONS
A number of factors are identified which may explain the different individual decisions and different levels of use of opportunistic screening in the different EU countries.
Department of Urology, Erasmus Medical Centre, Rotterdam, The Netherlands.
Fritz H
FH
Schröder
Louis
L
Denis
Monique J
MJ
Roobol
D000368:Aged; D001294:Attitude to Health; D001706:Biopsy / Q000379:methods; D055088:Early Detection of Cancer / Q000379:methods / Q000523:psychology; D005060:Europe / Q000453:epidemiology; D005062:European Union; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D015337:Multicenter Studies as Topic; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000523:psychology; D016032:Randomized Controlled Trials as Topic; D012111:Residence Characteristics; D018570:Risk Assessment
D017430:Prostate-Specific Antigen