Early Detection and Treatment of Prostate Cancer: a Road to Patient Benefit?

Abstract

Prostate cancer in most western industrial countries is a major healthcare problem. The disease is the second most frequent cause of cancer death with, in 1993, an incidence of 85.000 new cases per year, and almost 40.000 deaths in the European Community countries. It has been predicted that due to increasing male longevity alone the incidence (and mortality) will rise with by 50% by the year 2020 [1]. In addition to that, there is an unexplained continuous slow rise in prostate cancer mortality, and a much more pronounced rise in incidence, which is due to the availability of effective screening strategies, which are driven by the use of the determination of prostate-specific antigen (PSA) in serum. The use of early detection technology outside prospective randomised studies in situations where the value of early detection and early treatment is unproven is termed “opportunistic screening”. Accurate information on the frequency of opportunistic screening in the various European countries is unavailable. In the United States, where the American Urological Association and the American Cancer Society proposed screening for prostate cancer as a policy, it is estimated that 60–70% of all men above the age of 50 undergo PSA testing. In the area of Rotterdam, an area where a prospective randomised screening study is being conducted, it is estimated that 13% of men above the age of 55 undergo PSA testing [2]. In 1994 the same estimate in the same area amounted to only 9%.