ABSTRACT Screening for prostate cancer is a controversial topic within the field of urology. The US Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial did not demonstrate any

difference in prostate-cancer-related mortality rates between men screened annually rather than on an 'opportunistic' basis. However, in the world's largest trial to date—the

European Randomised Study of Screening for Prostate Cancer—screening every 2–4 years was associated with a 21% reduction in prostate-cancer-related mortality rate after 11 years. Citing the

uncertain ratio between potential harm and potential benefit, the US Preventive Services Task Force recently recommended against serum PSA screening. Although this ratio has yet to be

be combined with other predictive factors or be used in a more thoughtful way to identify men at risk of symptomatic or life-threatening cancer, without overdiagnosing indolent disease. A

risk-adapted approach is needed, whereby PSA testing is tailored to individual risk. KEY POINTS * Data regarding the potential effect of PSA-based screening on disease-specific mortality

rates are promising, but not yet sufficient to support definite conclusions * Screening for prostate cancer should focus on the detection of high-risk and potentially life-threatening

disease * Prostate cancer screening guidelines vary between different countries, medical organizations, and guideline groups; however, there is general agreement that screening should be

preceded by a discussion about risks and benefits * Elevated PSA and abnormal digital rectal examination (DRE)—routine tests in prostate cancer screening—demonstrate poor performance

characteristics; carefully selected combinations of other currently available tests could improve diagnostic accuracy * Multivariate risk prediction tools outperform PSA testing and DRE in

terms of predicting biopsy outcome; however, most of these tools lack calibration and external validation * Individualized screening is perhaps the most ethical approach to screening, but

requires both physicians and patients to be adequately well informed Access through your institution Buy or subscribe This is a preview of subscription content, access via your institution

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about institutional subscriptions * Read our FAQs * Contact customer support SIMILAR CONTENT BEING VIEWED BY OTHERS SERUM PSA-BASED EARLY DETECTION OF PROSTATE CANCER IN EUROPE AND GLOBALLY:

PAST, PRESENT AND FUTURE Article 16 August 2022 RISK CALCULATORS FOR THE DETECTION OF PROSTATE CANCER: A SYSTEMATIC REVIEW Article 03 June 2024 RETHINKING PROSTATE CANCER SCREENING: COULD

MRI BE AN ALTERNATIVE SCREENING TEST? Article 21 July 2020 CHANGE HISTORY * _ 23 APRIL 2013 In the version of this article initially published online and in print, descriptions of intact

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Google Scholar  Download references ACKNOWLEDGEMENTS S. V. Carlsson is supported by funding from the Swedish Cancer Society, the Swedish Society for Medical Research, the Sweden-America

Foundation, and the Swedish Council for Working Life and Social Research. M. J. Roobol is supported by the Dutch Cancer Society and the Prostate Cancer Research Foundation Rotterdam (SWOP).

The authors would like to thank Dr Stacy Loeb for independent review of the final manuscript before submission. AUTHOR INFORMATION AUTHORS AND AFFILIATIONS * Department of Urology, Erasmus

Medical Center, Rotterdam, 3000 CA, Netherlands Monique J. Roobol * Department of Surgery (Urology Service), Memorial Sloan-Kettering Cancer Center, New York, 10065, NY, USA Sigrid V.

Carlsson Authors * Monique J. Roobol View author publications You can also search for this author inPubMed Google Scholar * Sigrid V. Carlsson View author publications You can also search

for this author inPubMed Google Scholar CONTRIBUTIONS M. J. Roobol and S. V. Carlsson contributed equally to this work and independently performed literature searches and reviews. Both

authors wrote separate draft versions of the manuscript that were subsequently merged into one. Both authors then edited the article and approved the final manuscript prior to submission.

CORRESPONDING AUTHOR Correspondence to Monique J. Roobol. ETHICS DECLARATIONS COMPETING INTERESTS The authors declare no competing financial interests. RIGHTS AND PERMISSIONS Reprints and

permissions ABOUT THIS ARTICLE CITE THIS ARTICLE Roobol, M., Carlsson, S. Risk stratification in prostate cancer screening. _Nat Rev Urol_ 10, 38–48 (2013).

https://doi.org/10.1038/nrurol.2012.225 Download citation * Published: 18 December 2012 * Issue Date: January 2013 * DOI: https://doi.org/10.1038/nrurol.2012.225 SHARE THIS ARTICLE Anyone

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