Screening for prostate cancer - integrating the current evidence with informed decision making

Prostate cancer is a leading disease affecting men worldwide. Screening for prostate cancer aims to provide clinicians and patients with the opportunity to identify the cancer at an early stage, whereby survival can be increased due to availability and implementation of relevant treatment options. For screening practices to be unambiguous, a clear and reliable body evidence, such as those offered by randomised controlled trials (RCTs), must be available to demonstrate an increased survival rate in populations offered screening. A Cochrane systematic review in 2006 identified a lack of evidence to either support, or refute, the use of screening for prostate cancer. This lack of clear evidence from trials has subsequently been reflected in differing recommendations offered by professional medical entities. It was anticipated that the results from two ongoing large RCTs would provide definitive evidence on this important issue. Unfortunately, the recently published results from these two RCTs shed little light on this matter, as both offer conflicting recommendations on the benefits of screening for prostate cancer. In the absence of definitive evidence, be it currently or in the future, further emphasis must now be placed on informed decision making. Greater interaction between patients and doctors on this issue, and the ability to access quality evidencebased information, is required. This chapter will provide a commentary on this issue.