Abstract
In Japan, the numbers of patients with prostate cancer and deaths from the disease are both increasing as of now. Therefore, countermeasures against the disease are vital. Introduction of prostate specific antigen (PSA) screening has helped detect early-stage prostate cancer and increased the possibility of permanent cure. A study in Europe reports a 20% decrease in mortality by PSA screening and PSA tests are considered to be gaining importance. But there are opinions not necessarily recommending PSA screening from medical economic perspectives and in fact arguments exist regarding this issue. In addition, it is known that prostate cancer often develops as latent cancer with a higher incidence along with aging. We cannot ignore the fact either that early detection of cancer can lead to overdiagnosis on one hand, considering that a constant rate of well-differentiated, small-volume cancer is included in prostate cancer detected without subjective symptoms but only by increases in PSA levels. However, the exposure rate of PSA screening in Japan is low in the first place and we are not in the circumstances to accept advisory from the U.S. unrecommending PSA tests straight. Urologists are responsible for continuous efforts to provide patients with clear information on benefits and disadvantages of PSA screening, biopsies, and prostate cancer treatment and for establishment of a system to avoid unnecessary biopsies and overdiagnosis. This article explains these issues related to PSA screening and introduces part of studies to help avoid overtreatment including active surveillance of prostate cancer that is currently being examined.
