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Can magnetic resonance imaging solve the prostate cancer conundrum?

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The debate about prostate-specific antigen (PSA) testing for the diagnosis of prostate cancer continues to rage. The United States Preventive Services Task Force (USPSTF) and the equivalent Canadian body have both advised against PSA screening.1,2 On the other hand, many authoritative bodies, including the American Urological Association,3 the National Comprehensive Cancer Network (US), the American Cancer Society, the European Association of Urology,4 and our own Urological Society of Australia and New Zealand recommend that, instead of population-based screening, decisions about PSA testing of men aged 55–69 years should be shared by doctors and individual patients.

While the USPSTF acknowledged the potential benefit of PSA screening for reducing cancer mortality and morbidity, it decided that the significant potential harms outweighed this benefit. The ongoing impact on the patient’s quality of life of the side effects of the various treatments, such as erectile dysfunction and urinary incontinence, are well documented,5 but the diagnostic biopsy itself is also associated with potential morbidity and, if rarely, mortality.6,7

These harms can be summarised…