Prostate Cancer Screening

Cancer of the prostate gland, a disease primarily found in men over the age of 50, is the most common cancer in North American males. Given the significance of the disease in the male population, much effort has been placed on developing a test for its early detection at a curable stage. To date, prostate specific antigen (PSA), a protein produced by epithelial cells of the prostate, has been considered the best marker for prostate cancer. However, controversy has surrounded the measurement of PSA as a screening test. No randomized controlled trials have shown any definitive net benefit from the test. Accurate measurement of PSA sensitivity and specificity are difficult to obtain. Issues also surround the economic implications of mass screening, as well as the morbidity and emotional impact associated with unnecessary aggressive procedures performed on the basis of an elevated PSA. In evaluating PSA screening, one must consider several factors including the magnitude of the condition as a health care problem, the accuracy of the test, the effects of screening on outcome, and the possible associated risks and benefits.