As 107,000 men died of prostate cancer in Europe in 2018, this is not an indolent disease. It is responsible for >10% of all male cancer deaths. Most men are not aware that it is possible to have asymptomatic prostate cancer and are uninformed about the existence and value of the PSA blood test. Early detection of prostate cancer reduces the mortality rate and can be easily cured without unbearable side effects and at a rather low price. Advanced cancer is less amenable for cure, with substantial side effects and a significant reduction in quality of life, and has a high chance of becoming metastatic and castrate-resistant. Treatment of this late stage disease is costly and prolongs life with on average only two years. Most importantly, the quality of life of these men is poor. The arguments against PSA testing are focused on issues related to over-diagnosis and overtreatment. These arguments have led in some countries to a decrease in testing, which in turn has led to an increase in too late diagnosis. In this paper, we present the results of clinical trials on early detection, the risks and benefits of early detection using PSA testing, and a way forward for the EU Cancer Plan using the current EAU scientific guidance on early detection as a basis. We conclude that PSA can now be used in a more clever fashion to ensure that men are diagnosed early enough to be able to prevent meaningful clinical disease, increase quality of life, and reduce costs for healthcare systems.

(BELG J MED ONCOL 2020;14(7):321-6)