Screening for prostate cancer: current recommendations.

Recent studies have questioned the efficacy of PSA as a marker for the early detection of prostate cancer, but techniques are being investigated to improve the sensitivity and specificity of screening. It is hoped that new methods can differentiate between lethal and nonlethal cancers, thereby avoiding lead-time bias. Even with the current limitations of PSA, the combination of stage migration seen with screening, the recent Scandinavian study showing decrease of disease progression following surgical extirpation, and the known mortality in patients presenting with advanced disease help support PSA screening for prostate cancer. It is hoped that prospective, randomized, long-term screening studies, such as the PLCO and ERSCP trials, will show improved survival using the admittedly imperfect PSA marker in prostate cancer screening.