Prostate cancer continues to challenge urologists in their daily clinical practice. The recent developments in diagnosis and therapy of this disease face them with an endless demand for earlier detection of the disease and better or more effective treatment. This is a logical consequence of the rapidly increasing incidence of both localized and metastatic prostate cancer. This urological tumor is now the second leading cause of cancer-related death in men over the age of 50 years. Annually, more than 120000 new cases of prostate cancer are detected and more than 32500 men will die of this disease in the United States . There is no reason or indication that this trend is not followed in other parts of the developed world. Indeed, Moller Jensen et al. have described similar trends for prostate cancer in Europe and underline that with the greying population, an increasing number of men are at risk for this malignancy. Associated with these epidemiological features is an increasing awareness in older men of the incidence and consequences of this disease.
The lack of possibilities for early diagnosis is clearly reflected in the observation that a majority of patients continue to be diagnosed as having metastatic prostate cancer and therefore being no longer amenable to curative treatment. Many efforts have been made during the last decade to develop strategies for earlier detection, but no convincing and reliable screening method is yet available. Health authorities refuse to fund screening programs based on the currently available early diagnostic possibilities, including DRE (digital rectal examination), TRUS (transrectal ultrasonography), and PSA (prostaticspecific antigen). These diagnostic tools, used alone or in combination, have too poor a predictive value to be used in mass population screening. For the time being, case finding seems a reasonable alternative for increasing the early detection rate, whereby patients at risk are regularly (yearly) examined by their general practitioner (or urologist) on the occasion of ad hoc medical visits.