2011 Volume 38 Issue 6 Pages 789-793
The aim of this article is to explain the reason why PSA screening is necessary in Japan now. In regard to the number of patients, prostate cancer is the most prevalent cancer in male Japanese now. More than 10,000 Japanese men are dying of prostate cancer annually and the incidence and mortality rates of prostate cancer are rapidly increasing. In contrast, a marked earlier stage-migration of newly diagnosed prostate cancer and a steady decrease in prostate cancer mortality rate in the recent consecutive 15 years are noted in USA where PSA screening is much more prevalent than in Japan. A large-scale prospective randomized trial in EU has revealed that PSA screening does decrease prostate cancer mortality up to 20%. This life-saving effect of PSA screening can be enjoyed also in Japan because PSA exposure rate in Japanese male population remains quite low.
Without sufficient PSA screening, advanced stage prostate cancers are being diagnosed in nonnegligible number of Japanese men. Therefore, the optimal process of prostate cancer management in Japan can be summarized as to diagnose clinically significant prostate cancer within a curative window, to evaluate risk of prostate cancer precisely and to select proper treatment. To achieve this optimal management process, diagnostic process of prostate cancer should meet the following criteria: i) Propagation of efficient PSA screening program, ii) Decision of precise indication of prostate biopsy and iii) prostate biopsy method with optimal diagnostic ability. To stop the steady increase in prostate cancer mortality rate in Japan, item i) is essential. To make the PSA screening fruitful, item ii) and iii) are mandatory.