OBJECTIVES: To review evidence regarding the potential introduction of prostate 
cancer screening programmes and highlight issues pertinent to the management of 
screen-detected prostate cancer.
METHODS: Screening for prostate cancer is a controversial health care issue in 
general and urological practice. A PubMed database search was performed, 
followed by a systematic review of the literature, to examine the evidence base 
underlying prostate cancer screening.
RESULTS: A prostate cancer screening programme should satisfy several key 
postulates prior to its introduction. To date, several of these postulates have 
not been satisfied, and the evidence available for prostate cancer screening is 
currently insufficient to warrant its introduction as a public health policy. 
The natural history of screen-detected prostate cancer remains poorly 
understood, and recent evidence suggests that a screening programme may detect a 
large number of men with indolent disease who may be subsequently overtreated. 
Several randomised clinical trials are currently in progress and it is hoped 
that they will provide robust evidence to inform future practice.
CONCLUSIONS: National systematic prostate cancer screening programmes outside 
randomised clinical trial settings have not been implemented to date owing to 
lack of robust evidence that such programmes would improve survival and/or 
quality of life in men with screen-detected disease. Forthcoming results of 
clinical trials and the application of appropriate risk stratification to 
prevent overtreatment of indolent prostate cancer are likely to change practice 
in coming years.