How should PSA screening efforts be focused to prevent underdiagnosis and overdiagnosis of prostate cancer?

摘要

Identification of individuals who are at high risk of developing prostate cancer, and those who are not, is a difficult issue to address. Although the specific causes of prostate cancer initiation and progression are not yet known, considerable evidence indicates that both genetic and environmental factors have a role in the origin and evolution of this disease. Classic and molecular epidemiology studies have identified a number of potential risk factors associated with the development of prostate cancer. For example, a number of case-control studies have demonstrated familial clustering of prostate cancer: in the early nineties, Cater and co-workers1 concluded that men who have one first-degree relative with prostate cancer have a twofold increased risk of developing prostate cancer, while men with two or three affected first-degree relatives have a fivefold and 11 -fold increased risk, respectively.