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Prostate cancer is the most commonly diagnosed cancer in American men and the second leading cause of cancer deaths. In 2004, nearly 20 million men in the United States will be confronted with important decisions regarding early detection for prostate cancer. In brief, the dilemma is that because not all men with prostate cancer die of the disease, treatment is not necessary for some patients. However, an estimated 29,900 patients will die of prostate cancer in 2004. Therefore, differentiating between patients whose cancer is clinically insignificant and those whose disease will progress is a challenge. The NCCN Prostate Cancer Early Detection Clinical Practice Guidelines in Oncology provide a set of sequential recommendations detailing a screening and subsequent work-up strategy for maximizing the detection of prostate cancer in an organ-confined state while attempting to minimize unnecessary procedures.

For the most recent version of the guidelines, please visit NCCN.org

Although lung cancer is the leading cause of cancer-related death in the world and has an increased chance of cure if detected at an earlier stage, routine lung cancer screening is currently not recommended in the United States. Unfortunately, most patients with lung cancer present only after the onset of symptoms and have advanced disease that cannot be surgically resected. The overall 5-year survival rate for all patients with lung cancer is only 15%. When the cancer is detected at its earliest stage (pathologic stage IA), however, the 5-year survival rate is more than 70%. Although past randomized screening trials evaluating the use of standard chest radiography or sputum cytology have not resulted in lower mortality, recent studies suggest that computed tomography (CT) may have promise as a screening tool. This article summarizes experience over the past decade of using low-dose spiral CT imaging as a screening tool to detect early lung cancers in asymptomatic, high-risk individuals.

Since the first introduction of prostate-specific antigen (PSA) as a screening tool in the 1980s, the accurate diagnoses of clinically significant prostate cancer remains a challenge. Analysis of a correlation between PSA levels and prostate biopsies of men with PSA 3 ng/mL or less in the placebo group of the Prostate Cancer Prevention Trial suggested that no “normal” PSA level exists. With the acknowledgement that PSA level is considered a continuum rather than a dichotomous marker, accurately diagnosing clinically significant prostate cancer is even more challenging. Nomograms are increasingly being used as tools in the clinical setting to address this challenge. Through incorporating multiple clinical factors, such as PSA, digital rectal examination, age, race, prostate volume, family history, and previous negative biopsy, risk calculators can improve sensitivity of diagnosis over using a PSA cutoff alone. This article discusses the rational for the use of nomograms and the advantages and limitations for the most commonly used nomograms.