There are calls for a national screening programme for prostate cancer: what is the evidence to justify such a national screening programme?

Abstract

Introduction: Prostate cancer is the commonest cancer in men and a major health issue worldwide. Screening for early disease has been available for many years, but there is still no national screening programme established in the United Kingdom.

Objective: To assess the latest evidence regarding prostate cancer screening and whether it meets the necessary requirements to be established as a national programme for all men.

Methods: Electronic databases and library catalogues were searched electronically and manual retrieval was performed. Only primary research results were used for the analysis.

Results: In recent years, several important randomised controlled trials have produced varied outcomes. In Europe the largest study thus far concluded that screening reduced prostate cancer mortality by 20%. On the contrary, a large American trial found no reduction in mortality after 7-10 years follow-up. Most studies comment on the adverse effects of screening - principally those of overdiagnosis and subsequent overtreatment.

Discussion: Further information about the natural history of prostate cancer and accuracy of screening is needed before a screening programme can be truly justified. In the interim, doctors and patients should discuss the risks, benefits and sequelae of taking part in voluntary screening for prostate cancer.

Keywords: Prostate cancer; prostate-specific antigen; screening; systematic review.