Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Viewpoint
  • Published:

Does current evidence justify prostate cancer screening in Europe?

Nature Clinical Practice Oncology volume 2, pages 538–539 (2005)Cite this article

Screening for prostate cancer is worthwhile only if it detects potentially life-threatening tumors among asymptomatic men at a stage when lesions are curable, and if the prospect of benefit outweighs the potential for harm.1,2 The debate over the value of prostate cancer screening is often fuelled by vigorous advocacy rather than the presence of robust evidence.1

Annually, over 500,000 men worldwide are diagnosed with prostate cancer. Screening by serum prostate-specific antigen (PSA) testing is appealing because it identifies cancers localized to the prostate gland that are hence potentially curable. In contrast, most men diagnosed clinically already have locally advanced or (in a minority) metastatic cancers with a poorer prognosis depending on the extent of spread. Increasing age is a clearly established risk factor for prostate cancer. Having an affected first-degree relative doubles the risk of developing prostate cancer, although major susceptibility genes account for only 5–10% of cases.1 Secondary prevention through screening is thus the only population-based approach available.1 Here we review the evidence for prostate cancer screening with reference to UK criteria for the evaluation of a screening program.3

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

References

  1. Frankel S et al. (2003) Screening for prostate cancer. Lancet 361: 1122–1128

    Article  Google Scholar 

  2. Stanford JL et al. (2000) Urinary and sexual function after radical prostatectomy for clinically localized prostate cancer: the prostate cancer outcomes study. JAMA 283: 354–360

    Article  CAS  Google Scholar 

  3. The UK National Screening Committee (NSC) [http://www.nsc.nhs.uk/uk_nsc/uk_nsc_ind.htm]

  4. McGregor M et al. (1998) Screening for prostate cancer: estimating the magnitude of overdetection. CMAJ 159: 1368–1372

    CAS  PubMed  PubMed Central  Google Scholar 

  5. Draisma G et al. (2003) Lead times and overdetection due to prostate-specific antigen screening: estimates from the European Randomized Study of Screening for Prostate Cancer. J Natl Cancer Inst 95: 868–878

    Article  Google Scholar 

  6. Gann PH et al. (1995) A prospective evaluation of plasma prostate-specific antigen for detection of prostatic cancer. JAMA 273: 289–294

    Article  CAS  Google Scholar 

  7. Hakama M et al. (2001) Validity of the prostate specific antigen test for prostate cancer screening: followup study with a bank of 21,000 sera in Finland. J Urol 166: 2189–2191

    Article  CAS  Google Scholar 

  8. Thompson IM et al. (2004) Prevalence of prostate cancer among men with a prostate-specific antigen level ≤4.0 ng per milliliter. N Engl J Med 350: 2239–2246

    Article  CAS  Google Scholar 

  9. Thompson IM et al. (2005) Operating characteristics of prostate-specific antigen in men with an initial PSA level of 3.0 ng/ml or lower. JAMA 294: 66–70

    Article  CAS  Google Scholar 

  10. Bill-Axelson A et al. (2005) Radical prostatectomy versus watchful waiting in early prostate cancer. N Engl J Med 352: 1977–1984

    Article  CAS  Google Scholar 

  11. Oliver SE et al. (2000) Comparison of trends in prostate-cancer mortality in England and Wales and the USA. Lancet 355: 1788–1789

    Article  CAS  Google Scholar 

  12. Lu-Yao G et al. (2002) Natural experiment examining impact of aggressive screening and treatment on prostate cancer mortality in two fixed cohorts from Seattle area and Connecticut. Br Med J 325: 740

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. RM Martin is Senior Lecturer in Epidemiology, G Davey Smith is Professor of Clinical Epidemiology, and J Donovan is Professor of Social Medicine at the University of Bristol, Bristol, UK

    Richard M Martin, George Davey Smith & Jenny Donovan

Authors
  1. Richard M Martin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. George Davey Smith
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jenny Donovan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Richard M Martin.

Ethics declarations

Competing interests

Richard M Martin and Jenny Donovan are principal investigators on a randomized controlled trial of the potential population impact of PSA testing for prostate cancer in the UK (Comparison arm for ProtecT trial, CAP), funded by Cancer Research UK/UK Department of Health, and the NHS Health Technology Assessment Programme.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Martin, R., Smith, G. & Donovan, J. Does current evidence justify prostate cancer screening in Europe?. Nat Rev Clin Oncol 2, 538–539 (2005). https://doi.org/10.1038/ncponc0349

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ncponc0349

This article is cited by

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing