PSA screening remains highly controversial due to several important
disadvantages. More PSA is produced with prostatic enlargement and
in other benign conditions such as urinary tract infections. False
positive tests can then lead to unnecessary diagnostic workup with
invasive prostate biopsy. Another major problem with screening
programs in general is overdiagnosis of cancers that would not have
caused harm during the patient's lifetime. For example, many
prostate cancers have a relatively indolent behavior so may not
require diagnosis or treatment in a patient with limited life
expectancy. All forms of prostate cancer treatment have potential
urinary and sexual side effects, so reducing overdiagnosis and
overtreatment are critical public health issues. Because screening
has many proven benefits but also significant harms, there are
widely disparate guidelines on prostate cancer screening from major
organizations worldwide. This issue of the Urologic Clinics will
provide insights into the many different prostate cancer guidelines
and related policy issues.
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