Controversies in managing localized prostate cancer: introduction

Excerpt

With the widespread use of the prostate-specific antigen (PSA) test, the incidence of prostate cancer, particularly localized disease, continues to increase in Japan. Accordingly, the chance of managing localized prostate cancer has dramatically increased. With this background, one of the most important criticisms is possible overdiagnosis and overtreatment. The recently updated data in the European Randomized Study of Screening for Prostate Cancer indicated that, to prevent one death from prostate cancer at 11 years of follow-up, 1055 men would need to be invited for screening and 37 cancers would need to be detected [1]. Although the analyses after 2 additional years of follow-up consolidated the previous finding that PSA-based screening significantly reduced mortality from prostate cancer, screening for prostate cancer remains controversial because of the risk of overdiagnosis and overtreatment and the inability to detect a significant proportion of lethal tumors. The US Preventive Services Task Force recommended against PSA-based screening for prostate cancer (grade D recommendation) [2]. Considering the balance of harm and benefit, the recommendation statement concluded that the benefits of PSA-based screening for prostate cancer do not outweigh the harms. …