https://doi.org/10.1177/2051415818815395 Journal of Clinical Urology 2019, Vol. 12(2) 111–116 © British Association of Urological Surgeons 2018 Article reuse guidelines: sagepub.com/journals-permissions DOI: 10.1177/2051415818815395 journals.sagepub.com/home/uro Introduction Prostate cancer is the most common form of cancer in men, with 47,151 new cases in the UK in 2015, 11,631 deaths in 2016, and a 1 in 8 lifetime risk of developing the condition. 1 The mortality rates of prostate cancer remain too high: men have a 4.3% lifetime risk of dying from the disease. 2 Moreover, age-standardised mortality rates for prostate can- cer are higher than for comparable cancers with approved screening programmes, such as breast cancer 1 , highlighting the aggressive nature of a proportion of prostate tumours. Prostate-specific antigen (PSA)-based screening is attractive because it is relatively non-invasive, quick and cheap; however, while PSA-based screening for prostate cancer is commonly used in the USA, 3 no formal prostate cancer screening programme currently exists in the UK. Almost 50 years ago, when Wilson and Jungner published their renowned report on screening, 4 they recognised that although ‘…screening is an admirable method of combat- ing disease…’, ‘…the path to its successful achievement (on the one hand, bringing to treatment those with previously undetected disease, and, on the other, avoiding harm to those persons not in need of treatment) is far from simple…’. These remarks remain remarkably relevant in relation to screening for prostate cancer: empirical evi- dence for a PSA-based screening programme effectiveness is conflicting, and the overall benefits may not outweigh the harms. The controversy has been highlighted by the changing recommendations made by the US Preventative Services Taskforce, which provides guidelines for screening in the USA. In 2008, 5 they decided there was insufficient evidence regarding prostate cancer screening in men < 75 Obstacles in prostate cancer screening: Current issues and future solutions Benjamin Patel 1 , Seshadri Sriprasad 2 , Jeffrey Cadeddu 3 , Arron Thind 4 and Abhay Rane 1 Abstract Prostate cancer is the most common cancer in men and is associated with unacceptably high mortality rates, yet an accurate and acceptable screening programme that detects clinically significant prostate cancer remains elusive. Although there is good evidence that prostate-specific antigen (PSA)-based screening lowers prostate cancer-specific mortality, especially when conducted at high intensity, the harm caused by overinvestigation, overdiagnosis and overtreatment of clinically insignificant cases arguably outweighs these benefits. Several attempts have therefore been made to improve screening, enhancing the diagnostic value of PSA and identifying novel modalities for screening. Here, we provide a comprehensive review of the benefits and harms, and analyse which of these novel screening methods show most promise. Level of evidence: 5, expert opinion Keywords Prostate cancer, screening, PSA, prostatectomy, MRI, elastography Date received: 2 October 2018; accepted: 4 November 2018 1 Department of Urology, East Surrey Hospital, UK 2 Department of Urology, Darent Valley Hospital, UK 3 Department of Urology, UT Southwestern, USA 4 Department of Medicine, Croydon University Hospital, UK Corresponding author: Benjamin Patel, Department of Urology, East Surrey Hospital, Canada Avenue, Redhill, Surrey RH1 5RH, UK. Email: benjpatel@gmail.com 815395URO Journal of Clinical UrologyPatel et al. Prostate cancer. Critical Review