PROSTATE-CANCER - ENTHUSIASM FOR SCREENING

Recent articles in the Journal have suggested that screening for prost ate cancer is inappropriate and that intervention for localised diseas e, especially by means of radical prostatectomy, does more harm than g ood.(1-3) I question these viewpoints and present the case for screeni ng. Screening for prostate cancer is recommended by the American Cance r Society(4) and the American Urological Association,(5) but not by th e Australian Cancer Society,(6) the Urological Society of Australasia, (1) or the Royal Australian College of General Practitioners.(6) The a ttitudes of the latter organisations are based primarily on the fact t hat there is no current proof that screening will result in decreased numbers of deaths from prostate cancer. Studies are under way, but the se will take at least 10-15 years for final analysis. The key question then is: how should we advise our patients today? The naysayers belie ve that one should wait for the studies to be completed before advisin g patients. On the other hand, one can try to predict, from the availa ble information, what conclusions will eventually be reached. The reco mmendations for screening for breast cancer by mammography followed 10 -15 years of study which showed that it reduced the number of deaths f rom breast cancer.(7,8) For screening to be considered useful, three m ain criteria need to be satisfied: Is the disease a major health probl em? Is there effective treatment? Are the tests acceptable, safe, repr oducible and cost effective? Does prostate cancer screening meet these criteria now? I think yes and my reasons are as follows.