Value of prostate cancer screening.

The challenge for the future is to establish whether screening will lead to a decrease in prostate cancer mortality. This issue can only be settled by the performance of a properly controlled, randomized, prospective study. Due to the generally slow progression rate of prostate cancer, such a study will require an at least 15-year follow-up of a large number of men. Because of the increasing widespread use of prostate-specific antigen in the United States, finding a large control population who will not be screened for an extended period of time may no longer be possible. Nevertheless, such a study is clearly needed and is being undertaken by the National Institutes of Health. In the meantime, it is important that physicians counsel patients regarding the relative benefits and risks of screening so that they can make their own judgments regarding the aggressiveness with which the diagnosis of prostate cancer should be pursued.