Abstract
Screening is an attempt to identify individuals with a certain disease in a broad segment of the population - those for whom there is no reason to suspect the disease. The screening is performed if there is a high risk of a disease within a population, if a proper diagnostic method exists, and if there is the possibility to treat the disease effectively.
The term "early detection" is mainly used for the opportunistic or selective screening. The primary objective of screening is to reduce mortality while keeping the same quality of life as if no disease was diagnosed.
Secondary objectives are related to identifying more individuals in less advanced stages of the disease and mapping the incidence of the disease precisely in a respective region. The implementation of Prostate Specific Antigen examination played a key role for prostate screening.
In several countries, a large increase in incidence was seen, as was a decrease in metastatic stage identification. Nevertheless, the screening was still controversial, mainly for the uncertain impact on mortality reduction and for the diagnosis and treatment of clinically non significant stages and related adverse screening side-effects.
However, it was recently clearly demonstrated that most of the studies were not performed properly. Now there is a clear evidence that screening reduces mortality in case of 10-15 years of duration and this mortality reduction is the same as in other diseases for which screening is performed.
In accordance with the published literature, it is not a question if prostate screening should be performed, but how it should be performed. Screening, or the early detection program, should be performed selectively based on the recommendation of expert organizations regarding the epidemiological, health, structural and economic situation of a respective country, and regarding the individual health condition and wishes of an informed patient.
Recently, the main thesis of oncological prevention was defined by the Czech Oncological Society and by the Ministry of Health of the Czech Republic. The Czech Republic meets all the above mentioned professional requirements to perform selective prostate screening, particularly for a certain age group of men and for men with a history of other tumour disease with a life expectancy of 10-15 years.
There is now an agreement for screening performance for these populations between professional societies (the Czech Urological Society and the Czech Oncological Society, the Institute of Health Information and Statistics of the Czech Republic, the Ministry of Health of the Czech Republic, and the country's main health care payers.