Prostate cancer screening: tests and algorithms

Although the concept of early detection of cancer sounds intuitively logical it is not automatically so in the case of prostate cancer despite the fact that the data on incidence and mortality show that it is an important health problem. The fact that prostate cancer is in general a slow growing tumor mainly in elderly men raises the question whether early detection and available treatment (with related morbidity) will improve prostate cancer specific survival. The identification of PSA as a diagnostic tool, and an increased awareness of the disease by patients and doctors resulted in an increase in incidence of prostate cancer. Whether such early detection and treatment of prostate cancer will save lives can only be answered by a well performed randomized controlled trial. The European Randomized study of Screening for Prostate Cancer (ERSPC) is a multi centre study that has the power to investigate the impact of screening for prostate cancer on disease specific mortality. The ERSPC also provides a means to study the performance of screening tests in identifying men with an elevated risk of having prostate cancer in an asymptomatic population. This thesis concentrates on this subject.