To screen or nor to screen: the prostate cancer dilemma

Abstract

The European Randomized Study of Screening for Prostate (ERSPC) has updated their previous seminal report on prostate cancer mortality comparing screened men to controls. Now with 13 years follow-up, the rate ratio of prostate cancer mortality was 0.79 favoring the screened population. The authors concluded that there was a “substantial reduction in prostate cancer mortality attributable to testing with prostate-specific antigen (PSA)” but they also stated that a “quantification of harms” needed to be addressed. The issue of harms was not addressed by the ERSPC (at least not in this report) and hence this additional statement most likely reflects the controversy currently surrounding the risks associated with over-diagnosis and treatment of indolent diseases inadvertently detected by a screening protocol.1 In addition, the positive results from this trial conflict with those of the prostate, lung, colorectal and ovarian (PLCO)2 study and require further elaboration.

Prostate cancer characteristics and outcome in renal transplant recipients: results from a contemporary single center study

“…International guidelines suggest PCa screening by prostate‐specific antigen (PSA) and digital rectal examination (DRE) in all RTR male over 50 years of age with life expectancy of at least 10 years . Given that screening is nowadays controversial in the general population, it should also be questioned for RTR . Furthermore, PCa incidence is expected to increase in RTR: through the improved medical cares of RTR in the last decades, inducing a longer life expectancy and graft survival, and through the bias of screening, urologists will inevitably have to manage more RTR with PCa.…”

Differences in cancer characteristics of Chinese patients with prostate cancer who present with different symptoms

“…The main concerns surrounding the use of PSA testing for the detection of early prostate cancer are overdiagnosis and overtreatment. [8][9][10] Only approximately 36% of patients in the study cohort had very low-or low-risk disease that might not require aggressive intervention. 13,26 Even in those patients with prostate cancer diagnosed by PSA testing (ie groups 1 and 2), more than 50% were in the intermediate-or higher-risk groups.…”

“…6,7 One of the concerns is the risk of overdiagnosis and overtreatment of low-risk cancer that may result in more potential harm than benefit to patients. [8][9][10] There are many types of prostate cancer screening approaches. Currently, there is no structured prostate cancer screening programme in Asia.…”

Neue und bewährte Radiopharmaka für die Diagnostik und Therapie des Prostatakarzinoms

“…Primärtumoren der Prostata werden gegenwärtig durch digitale rektale Untersuchung (DRU) oder anhand eines erhöhten PSA-Wertes (Prostata-spezifisches Anti gen) diagnostiziert und zumeist mittels Nadelbiopsie und histo pathologischer Untersuchung bestätigt. Die Wertigkeit der PSABestimmung und insbesondere des PSAScreenings wurde jüngst in großen multizentrischen Studien, wie der ERSPCStu die in Europa [61] oder der PLCO-Studie in den USA [5] unter sucht, und neben der klinischen Aussagekraft werden assoziierte Aspekte wie die Lebensqualität der Patienten und die Gefahr der Überbehandlung kontrovers diskutiert [25,66]. Auf der Suche nach verlässlicheren und spezifischeren neuen Blutmarkern wurde der PHI, der "Prostate health index" vorgeschlagen, wel cher GesamtPSA, freies PSA, sowie die Isoform p2PSA ein schließt.…”