[bill_from_tampa]

This is a hot-button topic, which generates much heat. Most men (>80%) will have prostate cancer by the time they reach age 80 (ie, would be detected if their entire prostate was examined histologically (which is, you may surmise, not generally done). About 13% of men will be diagnosed with prostate cancer during their lifetime. About 2.9% of men will die because of prostate cancer.

Does anybody see the problem? Most men who will have prostate cancer develop will not die because of prostate cancer, but from something else -- and many of these men (most, actually) will have no idea they have or had prostate cancer ---> unless somebody goes looking for it.

A randomized controlled trial of prostate cancer detection using PSA was done in the US (sponsored by the NIH). It did not find any difference in the survival curves in men who were randomly assigned to PSA screening compared to those who were not so assigned. The trial has been criticised.

Obviously any man who had prostate cancer found through PSA testing and was treated and does not die from prostate cancer will be very happy, and convinced that the screening saved their life. But the actual RCT data is more complex, and PSA screening may simply be generating more "business" for urologists and radiation therapists, without providing real medical benefit.

Note that there are similar questions about another hot-button cancer screening topic, mammograms. But that is another chapter!