Redesigning Prostate Cancer Screening Strategies to Reduce Overdiagnosis

• Published in: Clinical chemistry (Baltimore, Md.) Vol. 65; no. 1; pp. 39 - 41
• Main Author: Vickers, Andrew J
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01.01.2019
• Subjects: Age; Antigens; Biopsy; Bladder; Cancer screening; Consent; Decision making; Diamond pyramid hardness; Disease prevention; Humans; Intestine; Male; Mass Screening - methods; Medical Overuse - prevention & control; Medical screening; Men; Morbidity; Mortality; Penis; Population studies; Prostate cancer; Prostate-Specific Antigen - blood; Prostatic Neoplasms - diagnosis; Prostatic Neoplasms - pathology; Radiation therapy; Rectum; Surgery; Systematic review; Task forces; Trends; United States > US
• ISSN: 0009-9147; 1530-8561
• DOI: 10.1373/clinchem.2018.287094

Overdiagnosis is a problem for prostate cancer because it is often coupled with overtreatment. Because of the proximity of the prostate to the bladder, penis, and rectum, curative treatment often leads to long-term urinary, sexual, and bowel symptoms. [...]men will experience similar treatment-related morbidity from surgery or radiotherapy as men with intermediate- or highrisk disease, for whom treatment is clearly indicated. In sum, application of some basic medical principles-avoiding screening, biopsy, or treatment in patients who are unlikely to benefit-coupled with recent findings on prostate cancer can transform PSA screening. [...]our question is not whether to screen for prostate cancer, but whether US medicine is prepared to make a few simple changes to ensure that we screen well. Carlsson S, Assel M, Sjoberg D, Ulmert D, Hugosson J, Lilja H, Vickers A. Influence of blood prostate specific antigen levels at age 60 on benefits and harms of prostate cancer screening: population-based cohort study.