Prevention and screening

Preventative medicine is well established in different areas, but it is still a relatively new concept in urology. Nutrition and environmental factors are suspected to play a major role in the prevention and/or progression of many cancers, including prostate cancer. Increasing evidence suggests that several dietary elements, particularly animal fat, vitamin E, vitamin D, selenium, and calcium, can interfere with the disease process. Large, prospective, randomised trials examining the effect of diet on prostate cancer should clarify these different aspects, allowing more specific dietary recommendations to be made. Extensive efforts have been made in recent years to facilitate the early detection of prostate cancer. Prostate-specific antigen testing has enabled the diagnosis of prostate cancer to be made 5-10 years earlier and shifted the disease stage at diagnosis towards more localised disease. However, screening for prostate cancer remains controversial. The results of large, ongoing, randomised trials, such as the European Randomised Study of Screening for Prostate Cancer, are awaited to determine the benefit of screening in terms of decreased mortality. Even if a benefit is shown, this must be balanced against changes in quality of life related to the potential morbidity of treatment before screening can be advocated. Over-diagnosis is also a significant potential problem from screening programmes; screening must become more specific for those men at risk of morbidity and death.

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