CONTROVERSIES IN PROSTATE-CANCER SCREENING - ANALOGIES TO THE EARLY LUNG-CANCER SCREENING DEBATE

The current debate regarding early detection and aggressive treatment of prostate cancer is fueled by the absence of controlled studies defi ning the risks and benefits of prostate cancer screening, and by the l ack of adequately powered trials demonstrating the benefit of curative treatment for early-stage prostate cancer. Pending the results of cli nical trials in 10 to 15 years, advocates of early detection of prosta te cancer with digital rectal examination and prostate-specific antige n have compared prostate cancer screening with the effective strategy of breast cancer screening, implying that prostate cancer screening sh ould similarly reduce cancer mortality. They have also cited the high burden of disease, the acceptable operating characteristics of digital rectal examination and prostate-specific antigen, a stage shift among cases detected by screening, and the theoretical curability of early- stage disease as sufficient reasons to proceed with screening. These a rguments, however, are reminiscent of earlier arguments in favor of lu ng cancer screening with chest x-ray examination and sputum cytology, a practice ultimately proven ineffective in clinical trials. We review ed published articles on lung and prostate cancer screening and identi fied many parallels. While prostate cancer screening may one day prove effective, analogies between the current prostate cancer screening co ntroversy and the older lung cancer screening debate should inject som e caution regarding widespread dissemination of prostate cancer screen ing without experimental evidence that such screening does more good t han harm.