Mortality results from the Göteborg randomised population-based prostate-cancer screening trial

To evaluate the early diagnosis and survival rates, the mortality-to-incidence rate ratio (MR/IR) was calculated from the IARC data. By comparing prostate cancer data between Asian men and North American men, we found that differences in the incidence rate and MR/IR could be attributed largely to a lack of annual prostate cancer screening with serum prostate-specific antigen (PSA) in most Asian countries. It is likely that PSA screening also contributes significantly to the differences in prostate cancer mortality rates. Prostate cancer has the highest incidence rate among five common malignancies in Asian Americans. However, the MR/IR ratio of prostate cancer is the lowest among cancers. These data seem to further support the usefulness of PSA screening, even though the percentage of low risk cancers is greater in prostate cancer than in other cancers. The low incidence rate of prostate cancer does not reflect the actual statistics of this disease in Asia. The data from limited institutions in many Asian countries seem to bias the true incidence and mortality rates. To improve this situation, incorporating PSA screening for prostate cancer, as well as constructing a nationwide cancer registration system, will be helpful.

Section: Prevalence Of Psa Screening In Men Over 50 Years Old Is Impementioning

confidence: 99%

Prostate cancer: an emerging threat to the health of aging men in Asia

Zhang¹,

Yang²,

Zhang³

et al. 2011

“…1 Initially, the role for hormonal treatment was restricted to men with metastatic and inoperable, locally advanced disease, but given the increase in prostate-specific antigen (PSA) testing, due to the recent PSA screening trials, [2][3][4] there has been a huge increase in the number of PCa cases detected. This earlier detection and downward stage migration has been accompanied by a proliferation of treatment alternatives, including its use as neoadjuvant or adjuvant therapy for surgery and radiotherapy, for biochemical relapse after surgery or radiation, and even as primary therapy for non-metastatic disease.…”

Section: Introductionmentioning

confidence: 99%

Quality of life issues in men undergoing androgen deprivation therapy: a review

Casey¹,

Corcoran²,

Goldenberg³

2012

Androgen deprivation therapy (ADT) has been an essential treatment option for treating prostate cancer (PCa). The role for hormonal treatment initially was restricted to men with metastatic and inoperable, locally advanced disease. Now it has been extended to neoadjuvant or adjuvant therapy for surgery and radiotherapy, for biochemical relapse after surgery or radiation, and even as primary therapy for non-metastatic disease. Fifty percent of PCa patients treated will receive ADT at some point. There is growing concern about the adverse effects and costs associated with more widespread ADT use. The adverse effects on quality of life (QoL), including physical, social and psychological well-being when men are androgen-deprived, may be considerable. This review examines the QoL issues in the following areas: body feminisation, sexual changes, relationship changes, cognitive and affective symptoms, fatigue, sleep disturbance, depression and physical effects. Further suggestions for therapeutic approaches to reduce these alterations are suggested.

“…4 Throughout the years, it became clear that the use of the PSA test in a screening setting has both advantages and disadvantages. The published results of the European Randomized study of Screening for Prostate Cancer (ERSPC), 5 the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial, 6 and the Gothenburg randomized population-based PC screening trial, 7 all initiated in the early 1990s, provide evidence on whether PSA testing is beneficial. The data from the three studies point towards a disease-specific mortality reduction due to screening, as well as the fact that screening by using a PSA test leads to overdiagnosis and therefore overtreatment.…”

Section: Introductionmentioning

confidence: 99%

PSA-based prostate cancer screening: the role of active surveillance and informed and shared decision making

Venderbos¹,

Roobol²

2011

Since the first publication describing the identification of prostate-specific antigen (PSA) in the 1960s, much progress has been made. The PSA test changed from being initially a monitoring tool to being also used as a diagnostic tool. Over time, the test has been heavily debated due to its lack of sensitivity and specificity. However, up to now the PSA test is still the only biomarker for the detection and monitoring of prostate cancer. PSA-based screening for prostate cancer is associated with a high proportion of unnecessary testing and overdiagnosis with subsequent overtreatment. In the early years of screening for prostate cancer, high rates of uptake were very important. However, over time the opinion on PSA-based screening has shifted towards the notion of informed choice. Nowadays, it is thought to be unethical to screen men without them being aware of the pros and cons of PSA testing, as well as the fact that an informed choice is related to better patient outcomes. Now, as the results of three major screening studies have been presented and the downsides of screening are becoming better understood, informed choice is becoming more relevant.