Intended for healthcare professionals

Clinical Review

Prostate cancer screening and the management of clinically localized disease

BMJ 2013; 346 doi: (Published 29 January 2013) Cite this as: BMJ 2013;346:f325
  1. Timothy J Wilt, professor of medicine, section of general internal medicine1,
  2. Hashim U Ahmed, Medical Research Council clinician scientist and clinical lecturer in urology23
  1. 1Minneapolis VA Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs (VA) Health Care System, and the University of Minnesota School of Medicine, Minneapolis, USA
  2. 2Division of Surgery and Interventional Science, University College London, London, UK
  3. 3Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
  1. Correspondence to: T Wilt tim.wilt{at}

Summary points

  • Increasing age is the most important risk factor for developing prostate cancer

  • The most effective way to reduce prostate cancer incidence is to reduce prostate specific antigen (PSA) testing or raise thresholds that define abnormality

  • Prostate cancer screening with the PSA blood test results in at most a small reduction in prostate cancer mortality and leads to considerable diagnostic and treatment related harms

  • Physicians should recommend against PSA screening for prostate cancer

  • Most men with prostate cancer detected by PSA testing have tumours that will not cause health problems (overdiagnosed), but almost all undergo early treatment (overtreated)

Prostate cancer is an important health problem. More than 40 000 incident cases of prostate cancer and more than 10 000 prostate cancer related deaths occur each year in the United Kingdom.1 Prevention, detection, and treatment of localized prostate cancer remain controversial. Although screening for prostate cancer with serum prostate specific antigen (PSA) testing is not approved in the UK, informal screening is common and has led to a threefold increase in the incidence of prostate cancer. In the United States, since the introduction of PSA screening more than 1.3 million men have been diagnosed with prostate cancer and one million of these have undergone treatment.2 We update a previous review, highlighting new findings that deal with clinical questions and future research needs for the prevention, detection, and treatment of clinically localized prostate cancer.3

Who is at risk of prostate cancer?

Established risk factors for prostate cancer include increasing age, black ethnic origin, and a family history of prostate cancer in a close male relative. The last two factors convey modest risk compared with age. Prostate cancer is rare before 50 years of age, and about 80% of cases and 90% of deaths occur in men over 65.3 Lower urinary tract symptoms (poor flow, urgency, frequency, hesitancy, nocturia) …

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