Individual and population-based screening

Prostate cancer (PCa) is a major public health issue. It is the second most common cancer among men worldwide and even the first one in Europe and the United States. In some Asian countries, PCa incidence has been rising rapidly over the last 20 years. The European Randomized Study of Screening for prostate cancer shows that prostate-specific antigen-based screening reduces the prostate cancer mortality by 21 % after 13 years of follow-up. However, population screening also leads to overdiagnosis and subsequent overtreatment which makes screening for PCa a controversial issue. It is necessary to find ways to detect only those cancers that need to be treated with the use of as few tests as possible. Some new predictive markers and tools have emerged for the detection of prostate cancer especially focusing on the detection of significant disease. They hold great potential to improve the screening process. Individual screening based on multivariate risk stratification can help to selectively identify high-risk patients and as such avoid unnecessary biopsies and overdiagnosis.