Can screening for early-stage prostate cancer be rationalized?

Prostate-specific antigen (PSA)-based screening identifies prostate cancer at an earlier stage than digital rectal examination alone. The widespread use of PSA as a screening tool has led to a marked increase in the incidence of prostate cancer and an apparent shift toward the diagnosis of earlier stage disease. Proof that PSA-based screening results in a reduction in prostate cancer-related mortality is lacking currently. Therefore, insufficient data are available to determine whether a general screening strategy should be adopted for detecting early-stage prostate cancer. Patients at average risk should be educated about the value of PSA testing. Patient groups at high risk should be the targets of aggressive screening initiatives.