Prostate cancer is the 5th common frequently diagnosed cancer and leading to increase cause of cancer death in men during last 10 years in Taiwan. In 2009, 4013 (4.6%) new cancer cases were diagnosed and 936 (2.3%) cancer deaths in men. Prostate cancer has a variable nature history, ranging from indolent to strikingly aggressive with a long preclinical phase. About 30 to 40% of patient s were diagnosed with locally- advanced stage now in Taiwan. Because we are still awaiting a breakthrough in the treatment of advanced disease, earlier detection of clinically significant disease currently seems to afford best opportunity of cure. There are two approaches to early detection: screen everyone within a certain age range or screen selectively based on risk factors. To date, PSA has been shown to be the single most significant predictive factor for identifying men at increased risk of developing prostate cancer. In October 2011, the United States Preventive Services Task Force (USPSTF) published draft
recommendations that health men under the age of 75 should not undergo PSA testing for prostate cancer screening. This leads to the update of guidelines in several associations in Europe and the Unite States regarding prostate cancer screening.
Widespread mass screening is not recommended because the achieved mortality reduction comes with considerable harm such as unnecessary biopsies, over-diagnosis, and subsequent overtreatment. There is several facts support the PSA screening. First, population-based modeling data suggest that widespread implementation of PSA screening explains a substantial fraction of recent declines in prostate cancer mortality in the Unite States. Second, the ERSPC identified a significant reduction in mortality associated with PSA-based screening. Third, the trial from the Scandinavian Prostate Cancer Study Group demonstrated clinically and statistically significant reductions in both prostate cancer-specific mortality and all-cause mortality among men treated surgically. The decision to undergo early PSA testing should be a shared decision between the patient and his physician based on the information balancing its
advantages and disadvantages.