Screening for prostate cancer

Abstract

Prostate cancer screening did not significantly decrease prostate cancer-specific mortality in a combined meta-analysis of five RCTs. Only one study (ERSPC) reported a 21% significant reduction of prostate cancer-specific mortality in a pre-specified subgroup of men aged 55 to 69 years. Pooled data currently demonstrates no significant reduction in prostate cancer-specific and overall mortality. Harms associated with PSA-based screening and subsequent diagnostic evaluations are frequent, and moderate in severity. Overdiagnosis and overtreatment are common and are associated with treatment-related harms. Men should be informed of this and the demonstrated adverse effects when they are deciding whether or not to undertake screening for prostate cancer. Any reduction in prostate cancer-specific mortality may take up to 10 years to accrue; therefore, men who have a life expectancy less than 10 to 15 years should be informed that screening for prostate cancer is unlikely to be beneficial. No studies examined the independent role of screening by DRE.

Variation in general practice prostate-specific antigen testing and prostate cancer outcomes: An ecological study

“…The similarity in mortality (prostate cancer‐specific and overall) in the four groups is in line with the findings by several studies and a recent Cochrane review on five screening trials . However, this contrasts the findings from the ERSPC, which found a small decrease in prostate cancer‐specific mortality in the screened group but not before 9 years of follow‐up .…”

Variation in general practice prostate-specific antigen testing and prostate cancer outcomes: An ecological study

“…The similarity in mortality (prostate cancer‐specific and overall) in the four groups is in line with the findings by several studies and a recent Cochrane review on five screening trials . However, this contrasts the findings from the ERSPC, which found a small decrease in prostate cancer‐specific mortality in the screened group but not before 9 years of follow‐up .…”

Comparison of prostate cancer survival in Germany and the USA : can differences be attributed to differences in stage distributions?

“…In contrast, in the USA, the proportion of localised stages was in 1998–2000 already higher than the proportion in Germany in 2007–2010 and no consistent changes over time were found. The already high incidence of prostate cancer seen in the USA in our present and previous studies , and the ever increasing incidence seen in Germany are likely to reflect the earlier introduction and more widespread use of PSA testing in the USA , as well as increasing application in Germany in later years , which does go along with a shift towards earlier diagnoses or localised tumour stage. However, the use of PSA testing in Germany is still far below the rates of the USA .…”

“…Furthermore, stage‐specific survival did not increase in our present study between 1997 and 2010 and in the Munich study between 1990 and 2010 . These observations, along with the increase in incidence in Germany, most likely reflect the effects of increasing opportunistic screening for prostate cancer among asymptomatic men , in which over‐diagnosis of indolent and slow growing tumours leads to overtreatment with no real gain in survival over time.…”

Changes in Prognostic and Therapeutic Parameters in Prostate Cancer from an Epidemiological View over 20 Years

“…Compendiously, the numbers of detected tumours correlate moderately with the numbers of PSA tests [9]. Altogether, this supports the assumption that the broad use of PSA tests starting in the 1990s in Europe has led to the augmented additional detection of many small tumours [10,11,12]. Presumably, this may be the main reason for the observed stage shift from capsule-penetrating to capsule-remaining tumours.…”

Variation in general practice prostate-specific antigen testing and prostate cancer outcomes: An ecological study

“…The similarity in mortality (prostate cancer‐specific and overall) in the four groups is in line with the findings by several studies and a recent Cochrane review on five screening trials . However, this contrasts the findings from the ERSPC, which found a small decrease in prostate cancer‐specific mortality in the screened group but not before 9 years of follow‐up .…”

Comparison of prostate cancer survival in Germany and the USA : can differences be attributed to differences in stage distributions?

“…In contrast, in the USA, the proportion of localised stages was in 1998–2000 already higher than the proportion in Germany in 2007–2010 and no consistent changes over time were found. The already high incidence of prostate cancer seen in the USA in our present and previous studies , and the ever increasing incidence seen in Germany are likely to reflect the earlier introduction and more widespread use of PSA testing in the USA , as well as increasing application in Germany in later years , which does go along with a shift towards earlier diagnoses or localised tumour stage. However, the use of PSA testing in Germany is still far below the rates of the USA .…”

“…Furthermore, stage‐specific survival did not increase in our present study between 1997 and 2010 and in the Munich study between 1990 and 2010 . These observations, along with the increase in incidence in Germany, most likely reflect the effects of increasing opportunistic screening for prostate cancer among asymptomatic men , in which over‐diagnosis of indolent and slow growing tumours leads to overtreatment with no real gain in survival over time.…”

Changes in Prognostic and Therapeutic Parameters in Prostate Cancer from an Epidemiological View over 20 Years

“…Compendiously, the numbers of detected tumours correlate moderately with the numbers of PSA tests [9]. Altogether, this supports the assumption that the broad use of PSA tests starting in the 1990s in Europe has led to the augmented additional detection of many small tumours [10,11,12]. Presumably, this may be the main reason for the observed stage shift from capsule-penetrating to capsule-remaining tumours.…”

Variation in general practice prostate-specific antigen testing and prostate cancer outcomes: An ecological study

“…The similarity in mortality (prostate cancer‐specific and overall) in the four groups is in line with the findings by several studies and a recent Cochrane review on five screening trials . However, this contrasts the findings from the ERSPC, which found a small decrease in prostate cancer‐specific mortality in the screened group but not before 9 years of follow‐up .…”

Comparison of prostate cancer survival in Germany and the USA : can differences be attributed to differences in stage distributions?

“…In contrast, in the USA, the proportion of localised stages was in 1998–2000 already higher than the proportion in Germany in 2007–2010 and no consistent changes over time were found. The already high incidence of prostate cancer seen in the USA in our present and previous studies , and the ever increasing incidence seen in Germany are likely to reflect the earlier introduction and more widespread use of PSA testing in the USA , as well as increasing application in Germany in later years , which does go along with a shift towards earlier diagnoses or localised tumour stage. However, the use of PSA testing in Germany is still far below the rates of the USA .…”

“…Furthermore, stage‐specific survival did not increase in our present study between 1997 and 2010 and in the Munich study between 1990 and 2010 . These observations, along with the increase in incidence in Germany, most likely reflect the effects of increasing opportunistic screening for prostate cancer among asymptomatic men , in which over‐diagnosis of indolent and slow growing tumours leads to overtreatment with no real gain in survival over time.…”

Changes in Prognostic and Therapeutic Parameters in Prostate Cancer from an Epidemiological View over 20 Years

“…Compendiously, the numbers of detected tumours correlate moderately with the numbers of PSA tests [9]. Altogether, this supports the assumption that the broad use of PSA tests starting in the 1990s in Europe has led to the augmented additional detection of many small tumours [10,11,12]. Presumably, this may be the main reason for the observed stage shift from capsule-penetrating to capsule-remaining tumours.…”