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Comment
. 2015 Jan-Feb;17(1):44-5.
doi: 10.4103/1008-682X.142770.

To screen or nor to screen: the prostate cancer dilemma

Nelson N Stone  1 , E David Crawford
Affiliations
Comment

To screen or nor to screen: the prostate cancer dilemma

Nelson N Stone et al. Asian J Androl. 2015 Jan-Feb.

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.

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Comment on

  • Quality-of-life effects of prostate-specific antigen screening.
    Heijnsdijk EA, Wever EM, Auvinen A, Hugosson J, Ciatto S, Nelen V, Kwiatkowski M, Villers A, Páez A, Moss SM, Zappa M, Tammela TL, Mäkinen T, Carlsson S, Korfage IJ, Essink-Bot ML, Otto SJ, Draisma G, Bangma CH, Roobol MJ, Schröder FH, de Koning HJ. Heijnsdijk EA, et al. N Engl J Med. 2012 Aug 16;367(7):595-605. doi: 10.1056/NEJMoa1201637. N Engl J Med. 2012. PMID: 22894572 Free PMC article.

References

    1. Heijnsdijk EA, Wever EM, Auvinen A, Hugosson J, Ciatto S, et al. Quality-of-life effects of prostate-specific antigen screening. N Engl J Med. 2012;367:595–605. - PMC - PubMed
    1. Andriole GL, Crawford ED, Grubb L, 3rd, Buys SS, Chia D, et al. Prostate cancer screening in the randomized Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial: mortality results after 13 years of follow-up. J Natl Cancer Inst. 2012;104:125–32. - PMC - PubMed
    1. Dall’Era MA, Albertsen PC, Bangma C, Carroll PR, Carter HB, et al. Active surveillance for prostate cancer: a systematic review of the literature. Eur Urol. 2012;62:976–83. - PubMed
    1. Ramirez-Backhaus M, Iborra I, Gomez-Ferrer A, Rubio-Briones J. Prostatectomy pathology findings in an active surveillance population. Arch Esp Urol. 2014;67:431–9. - PubMed
    1. Stone NN, Crawford ED, DeAntoni EP. and the Prostate Cancer Education Council. Screening for prostate cancer by digital rectal exam and prostate specific antigen: results of prostate cancer awareness week, 1989-1992. Urology. 1994;44:18–25.

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