Prostate cancer screening: And the pendulum swings

Abstract

The utility of prostate cancer screening has been 1 of the major issues in medicine for 25 years. Helgstrand and colleagues present a unique assessment demonstrating that screening reduces prostate‐specific mortality but also results in significant cancer overdiagnosis. See also pages 2931‐8.

Cancer Prevention and Control: Then and Now

“…The PSA test was developed to detect metastatic recurrence in prostate cancer patients, but in the 1980s, the PSA test was rapidly adopted as a screening test without evidence that it reduced mortality from prostate cancer. This led to an explosion in the number of prostate cancers diagnosed each year, peaking in 1992 [8,9]. Ultimately, it was recognized that the PSA test identifi ed a reservoir of indolent prostate cancers whose early detection and treatment did not decrease mortality.…”

“…Ultimately, it was recognized that the PSA test identifi ed a reservoir of indolent prostate cancers whose early detection and treatment did not decrease mortality. Prostate cancer screening guidelines have since been revised, and recommendations for PSA screening are much more limited to populations at increased risk [8,9]. This was one of the earliest examples of an "over diagnosis of cancer", in which screening detects nonlethal, early cancers.…”

The role of insulin-like growth factors in the development of prostate cancer

“…Over-diagnosis with screening results in many men being treated who would not have presented with symptoms during their lifespan and as treatment is commonly associated with complications, such as incontinence and impotence, this can result in considerable reduction in quality of life [4]. It has been estimated that screening results in 27 men being treated in order to save the life of one man [5]. The enthusiasm for screening in the USA led many to attribute the subsequent fall in mortality to early detection; however similar falls in mortality over the same time-span in countries without screening suggest this may be more complicated [5,6].…”

“…It has been estimated that screening results in 27 men being treated in order to save the life of one man [5]. The enthusiasm for screening in the USA led many to attribute the subsequent fall in mortality to early detection; however similar falls in mortality over the same time-span in countries without screening suggest this may be more complicated [5,6]. If mortality is presented as survival after diagnosis, then as adoption of screening results in a large increase in detected incident cases, this will misleadingly give the impression that there had been a major improvement in survival.…”