Overview of US Prostate Cancer Trends in the Era of PSA Screening

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Prostate cancer rates in the United States have changed radically over the last two decades. The introduction of prostate-specific antigen (PSA) screening impacted incidence substantially; however, in the absence of randomized clinical trials, its role in the precipitous mortality decline remains unclear. Simultaneous advances in treatment, shifting patterns of care, and changing health behaviors may also have contributed to this decline. Two veins of investigation–-ecologic and modeling studies–-provide insights into the benefits and costs of PSA screening, with the latter positioned to help design optimal intervention policies.