IS PROSTATIC-CANCER SCREENING NECESSARY

The controversy concerning the justification for prostatic cancer scre ening is now about ten years old. It is the consequence of several con vergent phenomena: the routine use of new diagnostic tools such as pro state specific antigen, ageing of Western populations, increased life expectancy and finally public health economic aspects. Is screening ju stified before the age of 50 years? The answer is no, except in high-r isk families with several cases of prostatic cancer, in which screenin g should be started at the age of 40 years. Is screening justified aft er the age of 70 years? The answer is no, except in men between 70 and 75 years whose general state and physiological age suggest that they have a life expectancy exceeding ten years. Is screening justified bet ween 50 and 70 years? There is no global ''medico-economic'' answer to this question, as medical truth, i.e. the individual's interests, app ears to be diametrically opposed to economic truth, i.e. the community 's interests, due to the high cost of screening. How can screening be envisaged for the future? In families with no particular risk, screeni ng should be clinical, but will probably start earlier and will contin ue later, because of the improvement of diagnostic tools and prolongat ion of life expectancy. In highrisk families, the development of genet ic tests will be able to determine whether or not a man has inherited predisposition genes. If he has inherited these genes, he will then be submitted to particularly early, meticulous and repeated screening.