Active surveillance vs radical prostatectomy

There are, in principle, two tests that can be used in mass screening, i.e. PSA assay and a DRE. The PSA test is simple, cheap, safe and acceptable, but prostate biopsy, which is required to investigate positive results, is less acceptable and carries significant risks. The accuracy (sensitivity and specificity) of the PSA test is difficult to determine [8]. There is no good standard against which to test it, because prostate biopsy itself can miss 10–30% of cases. Also, biopsies are not normally taken in men with a negative PSA test, so it is difficult to assess the number of false-negative tests and thus to measure the sensitivity of the PSA test. Testing does not differentiate between relatively harmless tumours and those that are likely to be fatal; therefore, the PSA test is not specific for clinically important disease. DRE is less acceptable and less accurate (i.e. has lower sensitivity and specificity) than PSA testing [8]. Comprehensive guidelines for managing prostate cancer were recently published by the European Association of Urology (available online at www.uroweb.org).