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Screening for Prostate Cancer: A Review of the Evidence in 2009

Robin Smart, MBChB(Otago), FRCS, FRCSEd, FRACS


Prostate-specific antigen (PSA), digital rectal examination (DRE), and transrectal ultrasound (TRUS) sector biopsy have been used internationally in the clinic for almost two decades. Over this time, the incidence of prostate cancer has approximately doubled [6,7]. Many countries, especially North America, Australia, and those in Western Europe reported decreases in prostate cancer mortality rates, ranging from 10–39%, due to increased screening. Despite this, many government authorities have promoted a negative approach towards screening. In this article, technological advances in TRUS sector biopsy, histological diagnosis, and disease management are discussed. In addition, changes in international prostate cancer mortality data and results from several clinical trials including the ERSPC (European Randomized Study of Screening for Prostate Cancer) and PLCO (Prostate, Lung, Colorectal, and Ovarian) cancer screening trial are reviewed.

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