Does PSA testing influence the natural history of prostate cancer?

Prostate-specific antigen (PSA) testing advances the diagnosis of prostate cancer, shifting the stage at diagnosis towards localised disease. However, the widespread application of PSA testing is controversial, due to uncertainties over whether earlier diagnosis of prostate cancer improves the mortality associated with the disease. This article discusses the evidence on the relationship between PSA testing and prostate cancer mortality considering 5-year survival rates, data from randomised, controlled trials and epidemiological trends in disease mortality. Reported improvements in 5-year survival rates for prostate cancer are probably due to lead-time bias (screening leading to earlier diagnosis). Randomised studies evaluating PSA screening are ongoing and will not provide mortality results until the latter part of this decade. Epidemiological data reveal a decline in disease mortality in areas where PSA screening is routine, but the cause of this decline is likely to be multifactorial. In conclusion, an effect of PSA testing on the natural history of prostate cancer is not yet fact, as determined by a randomised controlled trial, but it is certainly more than fiction. (C) 2002 Elsevier Science B.V. All rights reserved.