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Prostate cancer screening
Last reviewed: 07.07.2025
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In all countries, prostate cancer screening remains relevant. Data on the reduction of mortality due to the use of screening are contradictory. Since the organization of screening studies requires significant financial costs, it is necessary to resolve in advance the issues of the age of initiation and termination of screening examinations and the timing of repeated examinations.
The goal of prostate cancer screening is to reduce cancer mortality by early detection of tumors. Early diagnosis is performed using mass or individual examinations. The indicator of screening effectiveness is the reduction of prostate cancer mortality and ensuring a high quality of life. Detection of tumors and increased survival cannot serve as such an indicator, since early diagnosis itself contributes to increased survival (preemptive effect).
The dynamics of mortality from prostate cancer in developed countries varies. In the USA, Great Britain, France and Austria, its decline is occurring at approximately the same rate. The decline in mortality observed in recent years in the USA is often explained by mass examinations (based on the determination of prostate-specific antigen), but there is no definitive confirmation of this yet.
The importance of prostate cancer screening is supported by a study in Tyrol, Austria. After the introduction of a program for early detection and free treatment of prostate cancer, mortality from prostate cancer fell 33% faster than in the rest of Austria. A randomized trial in Quebec, Canada, also showed a reduction in mortality as a result of early detection. A comparison of prostate cancer mortality in Seattle, where mass screening was conducted, and Connecticut, where it was not, showed no significant differences, although Seattle residents were regularly tested for prostate-specific antigen (PSA) and were much more likely to receive radical treatment. Large randomized trials should determine the effectiveness of screening. Two such trials are underway in the United States and Europe; the first results are expected in 2008.
Thus, there is insufficient evidence to recommend mass screening for prostate cancer. The American and European Urological Associations recommend that all men over 50 undergo PSA testing and digital rectal examination. Only 8% of African Americans aged 40–50 with a hereditary predisposition were found to have pathology during examination, but 55% of them had a confirmed diagnosis of prostate cancer. This is why all patients at risk should undergo annual urological examination after age 40.
In economically developed countries, the population's awareness of prostate cancer is high and most men independently consult a doctor of any specialty to determine the PSA level. In Russia, cancer awareness is extremely low, so there is an objective need to create a system for informing potential patients and popularizing prostate cancer screening (local press, television).
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