Prostate cancer is the second most commonly diagnosed cancer in men and is a disease with significant heterogeneity. We could say that it is a condition with two faces:

• A theoretical “innocent” formwhich will not affect the patient’s survival or quality of life
• One more “aggressive” form which will soon become painful and deadly.

“Prostate cancer screening is a controversial topic in the field of urology. PSA should be combined with other prognostic factors, or used more carefully to identify men at risk of symptomatic or life-threatening cancer, without overdiagnosing the disease. A risk-adjusted approach is needed whereby PSA measurements are tailored to individual risk’ points out Mr IOannis Bouzalas Urologist – Director of 6th Urology Clinic, Clinic of Endourology and Minimally Invasive Treatment of Urolithiasis, Metropolitan General.

The purpose of population screening is to discover, within asymptomatic patients, those with prostate cancer:

• High grade malignancy
• At risk of developing metastatic disease

5 “golden” rules for prostate cancer screening with risk stratification

1. Obtaining consent (shared decision-making)
• Start discussions about the risks and benefits of PSA screening at 45-49 years
• Risk stratification of screening and adjustment of rescreening intervals to the man’s age, health and previous PSA
2. Don’t control men who won’t benefit
• Limit screening to older men
• Limit screening to men older than 60 years with PSA < 1 ng/mL
3. Do not biopsy without a compelling reason.
• Repeat the PSA.
• Prostate multiparametric magnetic resonance imaging (mpMRI)
4. Recommend active surveillance for men with low-risk prostate cancer
5. Refer men who need treatment preferably to specialized centers

“Prevention is an obligation of modern man towards himself and society as a whole. In all developed countries, the importance and necessity of preventive medicine is gaining more and more value. Many of the diseases of the modern world can be diagnosed early and thus successfully treated.

Today, early diagnosis is possible, as long as every man becomes aware of the problem and learns about it. The treatment of each case is unique, and while in men over 70 perhaps only monitoring is sufficient, in young patients the treatment must be immediate and aggressive,” concludes Mr. Bouzalas.