Population Based Screening for Prostate Cancer: assessment of diagnostic tools and cancers detected

Over the past decade, considerable debate has occurred over the question whether or not to screen asymptomatic men for prostate cancer. It is unknown whether early detection and treatment of the disease will decrease the disease specific mortality. On theoretical grounds screening may prove to be successful. If the disease is diagnosed at an earlier stage of its development in which it is still organ-confined; treatment of the disease has a higher chance of being curative. Comparisons have been made [1, 2]with the effective strategy [3, 4J of breast cancer screening. Similar parallels however, can be drawn between prostate and lung cancer screening in which a shift towards earlier (potentially curable) stage did not reduce ti,e disease specific mortality in screenees [5]. To conduct a randomized screening study with prost.lte cancer mortality as the major endpoint is one possible solution to the present controversy. For this purpose the European Randomized Study of Screening for Prostate Cancer (ERSPC) has been initiated [6]. The studies presented in this thesis are conducted within the Rotterdam section of the ERSPC to investigate the feasibility of screening and early detection of prostate cancer in the general population. Intermediate endpoints of the study are: 1. Assessment of the efficiency of the screening tests. Serum Prostate Specific Antigen (PSA) Digital Rectal Examination (DRE) and Transrectal Ultrasonography (TRUS). 2. To evaluate the morbidity related to the screening procedure. 3. To study tumor extent at the time of diagnosis.

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