Commentary: Prostate cancer is omnipresent, but should we screen for it?

In 1935, the pathologist Arnold Rice Rich reported on a study investigating his impression that microscopic prostate cancers could be detected at autopsy more commonly than were being diagnosed clinically.1 This study has been cited 215 times up to July 2006, and along with a 1954 autopsy series reported by LM Franks2 (cited 371 times), made a major contribution to our understanding of the natural history of prostate cancer. Rich’s study confirmed his intuition of a large disparity between microscopic prevalence of prostate cancer and its clinical incidence, in contrast with many other solid tumours where these differences are not as marked. This commentary discusses the contemporary relevance of these findings 71 years on, with a focus on their implications for understanding the epidemiology of prostate cancer and its early detection and treatment.