Rationale for randomised trials of prostate cancer screening

Screening for prostate cancer has been advocated by a number of organisatio ns largely because there is good evidence that administration of the test f or prostate specific antigen (PSA) results in the detection of cancers at a n early stage. However, the mere fact that a cancer can be detected earlier in its natural history by screening is no guarantee that benefit will foll ow. Further, screening for prostate cancer can substantially impair the qua lity of life of those with detected and treated cancer, that would not othe rwise have reduced Life expectancy. The only established mechanism to evalu ate the efficacy of screening is the randomised controlled trial. In this p aper we review the trials contributing to our collaboration, the advantages that will flow from them, and the reasons why decisions on the introductio n of population-based screening for prostate cancer cannot be made before t hese trials have come to fruition. (C) 1999 Elsevier Science Ltd. All right s reserved.