Prostate cancer screening may result in overdiagnosis of cancer

The recent release of two large randomized trials suggests that if there is a benefit of screening, it is, at best, small, says a new report in CA: A Cancer Journal for Clinicians.

Prostate cancer is virtually ubiquitous in men as they age, it is clear that a goal of “finding more cancers” is not acceptable. Instead, public health principles demand that screening must reduce the risk of death from prostate cancer, reduce the suffering from prostate cancer, or reduce health care costs when compared with a non-screening scenario.

This review is authored by Otis W. Brawley, M.D. of the American Cancer Society and Donna Ankerst, Ph.D. and Ian M. Thompson, M.D. of the University of Texas Health Science Center at San Antonio.

The authors suggest prostate cancer screening has yet to reach one of these standards to date.

No major medical group, including the American Cancer Society, currently recommends routine prostate cancer screening for men at average risk.

In the United States, prostate cancer will affect one man in six men during his lifetime. Prostate cancer is the most common cancer diagnosed in men in the UK also.

Since the mid-1980s, screening with the prostate?specific antigen (PSA) blood test has more than doubled the risk of a prostate cancer diagnosis. The review says a decrease in prostate cancer death rates has been observed since that time, but the relative contribution of PSA testing as opposed to other factors, such as improved treatment, has been uncertain.

The report says a computer modeling study using National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) registries estimated that more than one in four cancers detected in whites (29 percent) and nearly half of cancers detected in blacks (44 percent) were overdiagnosed cancers.

A similar model using data from Europe estimated a 50 percent overdiagnosis rate.

The authors say patients who are diagnosed with clinically insignificant tumors are subject to unnecessary diagnostic tests and unneeded treatment and suffer psychosocial harms. They are also labeled “a cancer patient,” which can have negative economic consequences. Also, say the authors, overdiagnosis significantly affects 5?year survival statistics, making them uninformative in demonstrating progress in cancer control.

The report says the future of prostate cancer will include better screening tests, better methods to assess a man’s risk of prostate cancer, and prevention strategies, including the use of finasteride, a drug currently used for the treatment of urinary symptoms related to prostate enlargement.

Source: American Cancer Society, USA



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