Smarter screening for prostate cancer: for the few, not the many? A stratified approach based on baseline risk.

Evaluation of: van Leeuwen PJ, Connolly D, Tammela TLJ et al. Balancing the harms and benefits of early detection of prostate cancer. Cancer 116(20), 4857-4865 (2010). Prostate cancer screening remains controversial, with different countries taking different views on its value. We review the study by van Leeuwen and colleagues, evaluating the risk-benefit ratio for screening from the European Randomized study of Screening for Prostate Cancer (ERSPC) stratified by age and serum prostate-specific antigen level at study entry. Though the overall results from the ERSPC demonstrated a 20% relative reduction in prostate cancer mortality in the screened arm, the current study demonstrated that the benefit was minimal for men aged 55-74 years with a serum prostate-specific antigen <4 ng/ml and came at the expense of significant overdiagnosis and overtreatment. This study adds to the growing body of evidence that prostate cancer screening works, but not for everyone, and suggests a smarter strategy of targeted screening to those most at risk from prostate cancer mortality.