Early Detection of Prostate Cancer

This chapter describes the design, main findings, relevance, and limitations of the European Randomized Study of Screening for Prostate Cancer (ERSPC), which compared screening based on prostate-specific antigen (PSA) to no screening. ERSPC indicated that screened patients may derive a small survival benefit in terms of prostate cancer–specific mortality but not all-cause mortality. Such a benefit is most likely realized in men with an extended life expectancy of 15 years or greater. The potential harms of PSA-based prostate cancer screening include a high rate of false-positive tests, biopsy-related complications, the unnecessary diagnosis of low-risk prostate cancer unlikely to affect a man during his lifetime (overdiagnosis) in some, and treatment sequelae both in men who may benefit from treatment and those who will not (overtreatment).