At the present time the majority of cases of prostate cancer in the United Kingdom are identified following “opportunistic screening” or “case finding” whereby men present to their clinician for one of a number of other reasons and then undergo PSA-testing, ideally following appropriate and adequate counselling. A smaller proportion of cases are identified following clinical presentation with lower urinary tract symptoms or with the symptoms related to advanced prostate cancer. There are a number of problems and controversies surrounding the diagnosis of early organ-confined prostate cancer. Firstly, the PSA test has considerable limitations in its sensitivity and specificity (Schroder et al. 2000), and the result can be difficult.
