The treatment of patients with clinically insignificant cancer would lead to unnecessary morbidity. Notwithstanding these issues, however, definitive treatment of prostate cancer is potentially curative if the disease is confined to the prostate gland when diagnosed. Although the evidence is not conclusive, there are data that suggest a greater proportion of cancers being detected by screening are organ confined and that the majority of these tumours may be clinically significant. Whether or not this will result in an improvement in the survival rates in prostate cancer remains to be seen. The Alberta Clinical Practice Guidelines Program supports the right of the patient to make an informed decision about his health care options.
Patient education is paramount in decisions surrounding prostate cancer.
It is important for asymptomatic men to be aware of the consequences of their decisions to be screened or not screened. Before deciding on testing, the patient should consider the procedures that would necessarily follow an abnormal result and whether or not he would want to be treated if cancer were diagnosed. In particular, men with a life expectancy of less than 10 years should be advised that screening is unlikely to be helpful and may worsen the quality of their lives. If a patient wishes to proceed with screening after discussion of the risks and benefits associated with diagnosis and treatment of prostate cancer, then DRE combined with PSA is indicated. The positive predictive value of the two tests is better than each alone.