Selections from current literature: PSA screening for prostate cancer.

Prostate cancer has been the focus of several recent reports in the US news media.Additional attention has been focused on this issue due to the disclosure by several prominent US individuals that they have or have had prostate cancer. These include US presidential candidate, Senator Robert Dole, Gulf War hero, retired General Norman Schwarzkopf and the billionaire financier Michael Milken. Such specific cases highlight the fact that prostate cancer—'the man's cancer'—has risen sharply both in incidence and prevalence over the last few years. In men, prostate cancer is the most common type of cancer in the US and the second leading cause of cancer mortality. In 1996, it is estimated that there will be 317 100 new cases and 41 400 deaths as a result of prostate cancer in the US. The lifetime probability of a man developing prostate cancer is one in five. Currently the adjusted death rate from this disease among men living in industrialized countries of the world is greater than 15 per 100 000 population. What has caused this epidemic? A partial answer is the use of prostate specific antigen (PSA) as a screening test which has led to the diagnosis of many cancers that would have otherwise have remained undiagnosed, and never become clinically significant. This then leads to the question now being debated in the literature, fuelled by contradictory guidelines from several highly respected agencies: to screen or not to screen with PSA? The American Cancer Society (ACS) and the American Urological Association (AUA) currently recommend annual PSA testing for all men aged 50 years and older. The American Academy of Family Physicians (AAFP), Canadian Task Force on the Periodic Health Examination (CTF) and National Cancer Institute (NCI) all recommend against routine PSA screening in asymptomatic men. Furthermore, the recently published guidelines by the United States Preventive Services Task Force (USPSTF) also recommend against routine PSA screening.