Clinical and economic consequences of screening for prostate cancer - the Swedish approach

• The outcome of two large-scale randomized controlled studies on prostate cancer screening from Europe and the USA are expected within three years. Together with a third large trial already performed in Quebec, Canada, they will hopefully provide some form of evidence for or against screening within the near future, although the results of such studies must be interpreted with caution. The effectiveness of a screening programme depends on the cancer prevalence, demographics, socioeconomic conditions, and treatment traditions in the country where it is performed, which limits the external validity of such studies. The prevalence of prostate cancer is relatively high in Sweden, which theoretically would favour screening. Treatment with curative intent, however, is not as well established as in other countries, despite the fact that the only randomized controlled study published so far with sufficient power to show prolonged cancer-specific survival following radical prostatectomy was performed in Sweden. As watchful waiting is often favoured in Sweden, even for men with localized tumours, the benefit of early detection is reduced. The positive as well as negative economic consequences of prostate cancer screening also have to be considered before a screening programme is started. All these circumstances emphasize the fact that the decision to introduce a screening programme has to be taken at the national level. No study can provide an outcome that can be set as an international standard. Three large trials of prostate cancer screening have been performed in Sweden, but screening on a broad scale has not yet been recommended.

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