Screening for prostate cancer. Role of ultrasonography.

Over the next 10 years, prostate cancer will be the cause of death in a large number of men. Perhaps the most feasible approach to reducing this mortality is early detection. The initial studies with transrectal ultrasonography demonstrate that this test is capable of detecting prostate cancers that are not detected by the digital rectal examination. A reasonable conclusion from these data is that every man over age 50 should have a sonogram as part of his annual check-up. Unfortunately, routine screening may also lead to serious morbidity, yet it may not lower the mortality rate from this disease. Therefore, before screening is recommended, randomized controlled clinical trials are needed to assess the impact of routine sonograms on asymptomatic men. These trials will be costly and time-consuming, but worthwhile, as the variable biology of this tumor means that screening may not accomplish its stated goals. That is, it is entirely possible that life-threatening tumors will not be detected by screening in time to alter the outcome, whereas many of the potentially curable tumors that are diagnosed and treated would never have caused a man's death. The initial results with screening by ultrasonography are encouraging, however. Therefore, further studies should be pursued because of the potential benefit if screening by ultrasonography proves effective.