This phenomenon brought a tremendous increase in the annual incidence of newly diagnosed prostate cancer cases in the early 1990s. This trend has recently reverted, and now we are seeing a decrease in this incidence. 1 Mortality from prostate cancer has decreased as well. Some speculate that this decrease in mortality is a consequence to the use of PSA and early detection. Many patients are treated at this stage with hormonal therapy.
Early detection is more precise now than it was only five years ago.
The introduction of the percent-free PSA defines better which men may benefit from a prostate biopsy when the total serum PSA is marginally elevated. A large US screening trial makes a compelling argument for screening. An improvement in the detection of clinically significant, earlier cancers when men are followed up with yearly PSAs is reported. A recent Canadian study by Labrie et al 5 presented at this year's annual meeting of the American Society of Clinical Oncology and the American Urological Association reports improved survival in men followed with periodic determinations of PSA compared with a non-followed control group. Statisticians have cautioned on the methodology of the study and the disproportionate increase in survival therein reported.