Screening for Prostate Cancer

3 Dec

Areas of Uncertainty

A medical Doctor from the Departments of Medicine and Family and Community Medicine, University of New Mexico faces an apparently common problem exposed below:

The answer is far more complex than it appears at first glance:

Screening for Prostate Cancer

Is it useful? but overall is it safe ? Prostate biopsies can lead to death by septicemic shock in those days of increasing resistance to antibiotics. The questions rises more and more interest among men of fifty years of age and over. A recent article in the New England Journal of Medicine, the well known scientific medical journal, describes the state of the art. First of all we must keep in mind that not one prostate cancer equals another in term of prognostic and treatment. In the prostate area, cancer cells don’t necessary mean immediate treatment nor life threat. If screening is useful automatic treatment is not, at least not in all cases. The key word is: watch full waiting (or armed surveillance) in numerous of cases which only the urologists are skill to differentiate. Passed an age that the urologist has to determine given the co morbidities in presence, active treatment would bring more harm and adverse events than positive results.

One thing is granted for sure and has always to be kept in mind: prostate cancer is the second man killer just behind lung cancer. In the fight against this sort of killer primary cares Doctors, surgeons and epidemiologists have still a long uneasy road ahead to ride… and patients have to be patient and above all thing well educated and informed.

Anyway some searchers inferred that mathematically PSA screening should have played a role in 45% to 70% of the overall decline of prostate cancer deaths observed since 1994 but this didn’t resulted from a high level of proof study (not a randomized control trial).

18. Etzioni R, Tsodikov A, Mariotto A, et al. Quantifying the role of PSA screening in the US prostate cancer mortality decline. Cancer Causes Control 2008;19:175-81.

Randomly Controlled trials failed by two times to prove that a decline in overall mortality was attributable to screening. But the maximum follow-up is only 9 years. We can not exclude that a favourable effect can still happen beyond 10 year.

24. Holmberg L, Bill-Axelson A, Helgesen F, et al. A randomized trial comparing radical prostatectomy with watchful waiting in early prostate cancer.N EnglJ Med 2002;347:781-9.

According to other searchers 23 to 42 % of screened prostate cancers wouldn’t have cause neither any clinical problem nor the death of the patient during the remaining life time of the patient. Said differently 23 to 42 % of screened cancer were over diagnosis (which is not the same as false diagnosis).

23. Draisma G, Etzioni R, Tsodikov A, et al. Lead time and overdiagnosis in prostate specific antigen screening: importance of methods and context. J Natl Cancer Inst 2009;101:374-83.

Read the entire paper here: nejmcp1103642



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