Are there effective techniques for prostate cancer screening?
Since PSA evolved as a screening tool in the late 1980s, screening for prostate cancer has spread dramatically. PSA has become the major tool for early prostate cancer detection. As the first step in a screening programme it is used to select those men who should undergo further diagnostic procedures. It may be performed in combination with digital rectal examination and transrectal ultrasound, although this adds little to sensitivity or specificity and is often considered unnecessary (Schrder, 1998). Regular screening programmes and uncontrolled opportunistic screening has lead to a dramatic increase in the detection of prostate cancer, although evidence supporting the benefits of screening are still lacking. In a retrospective review of men undergoing radical prostatectomy, it was found that widespread early detection programmes for prostate cancer resulted in a downward stage migration (Han, 2004), but the outcome from studies of this design are difficult to interpret and may be bia
