Rural residence and prostate cancer screening with prostate-specific antigen.

Prostate cancer mortality worldwide has recently decreased by 6% after peaking in the 1990s. Based on the recently published results of the European Randomised Study for Screening of Prostate Cancer (which showed a relative prostate cancer mortality reduction of at least 20% by PSA-based population screening) it could be assumed that this decrease is in part due to the implementation of prostate-specific antigen (PSA) screening. The existing large rural-urban inequality in prostate cancer mortality rates can be now associated with the different rates of prostate cancer screening between men who live in capital cities and men who live in regional and rural areas. Given the adverse effects of PSA-based prostate cancer screening in terms of over-diagnosis and over-treatment, research is needed to develop effective methods for cancer prevention and early detection services in rural populations. In the meantime, the introduction of intervention strategies is needed to augment existing prostate cancer screening methods.