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Three of six examiners considered DRE significantly more often suspicious than the others. However, under equal circumstances a suspicious DRE executed by each examiner increased the chance of the presence of PC similarly.

PSA-based screening detected a considerable amount (15.2%) of potentially aggressive tumors as T1cs, but in addition large numbers of possibly insignificant cancers (T1c, GS = 6) were diagnosed. DRE seemed to detect more selectively high-grade cancers, but also missed many of these. Considering both populations and the need to detect aggressive but confined cancers, PSA as biopsy indication outperformed DRE at the price of more biopsies (13.5% vs. 100% if all would comply).

SUMMARY Screening for prostate cancer at low prostate‐specific antigen (PSA) levels (≤4.0 ng/mL) risks detecting clinically insignificant cancers, which are of no threat to the man. In this review we evaluate the prevalence and tumour characteristics of prostate cancer detected at low PSA levels, comparing screening studies, cystoprostatectomy series and autopsy data. The favourable characteristics of tumours detectable at very low PSA levels seem to justify the conclusion that an unknown but sizeable proportion of the cancers found at biopsy are clinically insignificant.

Although screened men 55 to 75 years old with a father or a brother having prostate cancer themselves are at a substantially greater risk for the disease, the clinical presentation, treatment modalities and prognosis by biochemical progression are not different compared to sporadic cases.