Changing status of investigations for prostate cancer detection

Before the introduction of serum prostate specific antigen for the early detection of prostate cancer, this condition was diagnosed at an advanced stage, with palliative androgen deprivation therapy the mainstay of management. Increasing use of prostate specific antigen testing has resulted in a significant stage shift from locally advanced/metastatic disease to early stage, lower volume prostate cancer. Prostate specific antigen testing provides the potential for life-threatening disease to be detected early enough for effective treatment. However, many asymptomatic men with low-risk prostate cancer have also had what were, in retrospect, unnecessary diagnostic procedures and treatments leading to management-related morbidity. This manuscript traces the changes that have occurred and are occurring to refine detection, with the integration of new technologies to uncouple diagnosis from management so that potentially curative treatment can be tailored to those who are most likely to benefit.