Editorial Comment: A 16-yr Follow-up of the European Randomized study of Screening for Prostate Cancer

Abstract

This is the 16 years follow-up of the European Randomized study of Screening for Prostate Cancer (ERSPC) that was initiated in 1993 and previously published with 9, 11, and 13 years of follow-up (1-3). This trail try to elucidate the effect of regular prostate-specific antigen (PSA) screening on prostate cancer (PCa) mortality. This paper shows that the absolute reduction in PCa mortality still increases with longer follow-up, while the relative risk reduction remains at 20% since the initial report (1-3). There is still a 41% excess incidence in the screening arm. The median follow-up from diagnosis is modest (8.8 years in the screening arm and 5.4 years in the control arm) given the natural course of PCa. The number needed to diagnose for averting one PCa death was 18 in this update paper and was much higher in the previous ones. This high level evidence publication shows that the absolute effect of screening on PCa mortality increases with longer follow-up.

Infrared Visualization of the Prostate Cancer

“…On the other hand, usage of PSA and DRE may lead to overdiagnosis and lower quality of life (QOL). 2,3 The issue of unnecessary prostate cancer testing, overdiagnosis, and overtreatment eventually led to changes in prostate cancer guidelines. Since the 2012 update of the US Preventive Services Task Force (USPSTF), 4 a decrease in the diagnosed cases of localized prostate cancer and an increase in the confirmed cases of locally advanced/metastatic disease have been recorded after s significant reduction in PSA testing of the USA population.…”

Benefit, Harm, and Cost-effectiveness Associated With Magnetic Resonance Imaging Before Biopsy in Age-based and Risk-stratified Screening for Prostate Cancer

“…The use of multiparametric magnetic resonance imaging (MRI) as a triage test before biopsy in men with a clinical suspicion of prostate cancer has been shown both to be cost-effective and to be associated with a number of benefits, including the avoidance of unnecessary biopsies in approximately one-third of men, an improved detection rate of clinically significant cancer, and a reduction in the detection of clinically insignificant cancer . Although screening using prostate-specific antigen (PSA) is associated with a 20% reduction in prostate cancer–specific mortality, the harms of overdiagnosis and overtreatment are considered to outweigh this benefit in most men . As a result, formal, population-based screening is not currently recommended in any jurisdiction.…”

A Abordagem Do Psicologo Hospitalar No Cuidado Com a Criança Hospitalizada

“…No Brasil, campanhas que incentivam o rastreamento do câncer de próstata, com a dosagem do antígeno prostático específico (PSA -sigla em inglês) e exame digital retal, têm sido realizadas anualmente, a partir dos 50 anos, conhecidas como "Novembro Azul" como descrito pela Sociedade Brasileira de Urologia (2017), cujo objetivo é realizar o diagnóstico precoce, aumentando, teoricamente, a probabilidade do sucesso do tratamento, a sobrevida e a qualidade de vida do paciente, como descrito por Steffen (2018). É importante destacar que, quanto maior o tempo de seguimento, há maiores benefícios, sendo um único rastreio insuficiente para ter efeito na mortalidade, como observado por Hugosson (2019).…”

“…Entretanto, é válido ressaltar que existem literaturas que defendem o rastreio do câncer prostático, afirmando que há redução da mortalidade com o rastreio do PSA e que há mais benefícios quanto maior o tempo de seguimento, ou seja, é um processo contínuo, havendo pouco proveito em um rastreio único, como visto por Hugosson (2019). Estima-se evitar duas mortes para cada 1000 homens que são submetidos ao rastreamento, a partir da dosagem de PSA, como descrito por Grossman (2018).…”