As a significant public health problem, prostate cancer meets nearly all the criteria for screening. While concerns about incomplete natural history, progression rates and need for better prognostic factors are valid, important social and public health issues also need consideration. If future expenditures for terminal cancer care are minimized via reductions in therapy choices or coverage, no economic benefit for prostate cancer screening should exist. Narrowly focused attempts at cost reduction could inappropriately discourage highest risk groups from participating in early detection programs, thereby eliminating the greatest potential benefit of screening. The ACS-NPCDP has demonstrated that early detection of prostate cancer produced distinct stage migration to earlier, more curable disease through optimized use of DRE, TRUS and PSA. PSA is the most objective test and detects tumors of significant biologic potential. Current cost savings are possible with improved public health education about the appropriateness of early detection in the oldest age groups or those with significant pre-existing medical conditions. Prostate cancer control perhaps requires a tailored approach of screening in high risk groups and more appropriate "case finding" in the lower risk general population. The initial combination of PSA and DRE represents an ethical and economical choice for individual patients consulting with informed physicians.
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