Prostate Cancer, Gothenburg and Rotterdam

Since the introduction of serum prostate-specific antigen (PSA) testing in the late 1980s, prostate cancer incidence has risen sub-stantially, mainly due to mass screening of clinically asymptomatic men ( 1). In 1984, 5.1 % of all newly diagnosed prostate carcinomas were detected by PSA testing. By 1990 this percentage had already increased to 60.6 % of prostate cancers that were diagnosed in the United States ( 2). Screening for prostate cancer remains a contro-versial issue. There is still a lack of scientific data that prove the effectiveness of PSA screening with respect to the prevention of deaths from prostate cancer and whether it will outweigh the loss of quality of life due to overdetection ( 3) and overtreatment and will justify the expenditure of a considerable part of the total budget of health care resources ( 4). The European Randomized Study of Screening for Prostate Cancer (ERSPC) ( 5) was initiated with the intent to show or exclude an effect of screening on prostate cancer mortality. In addition, the ERSPC will allow a risk-to-benefi t analysis, includ-ing parameters of quality of life and costs. Variations in the screening protocol, particularly in the interval between different screening rounds, are likely to infl uence the outcome of screening, whereas the length of the screening interval affects the detection rate, effi cacy, and costs ( 4)