Updated Japanese Urological Association Guidelines on prostate‐specific antigen‐based screening for prostate cancer in 2010

Abstract

Abstract:The exposure rate of screening for prostate cancer using prostate-specific antigen (PSA) in Japan is still very low compared with that in the USA or western Europe. The mortality rate of prostate cancer will increase in the future and in 2020 it will be 2.8-fold higher than in 2000. Therefore, there is an urgent need to determine the best available countermeasures to decrease the rate of prostate cancer death. PSA screening, which can reduce the risk of death as a result of prostate cancer, should be offered to all men at risk of developing prostate cancer with fact sheets showing updated benefits and drawbacks of screening for prostate cancer.Key words: prostate cancer, PSA, screening, guidelines. Policy statement of the Japanese Urological Association on screening for prostate cancerThe Japanese Urological Association (JUA) recommends prostate-specific antigen (PSA) screening, which can reduce the risk of death as a result of prostate cancer, 1 for men at risk of prostate cancer. The recommendation is based on fact sheets showing the benefits and drawbacks of screening for prostate cancer. The JUA provides the best available screening system for men who want to be screened. Theoretical background of the policy statement1 The exposure rate of screening for prostate cancer using PSA in Japan is still very low compared with that in the USA or western Europe. Therefore, many clinically significant cancer cases in Japan might be undetected and missed until they develop into clinically advanced disease.2 At present, approximately 30% of newly detected prostate cancer cases have bone metastases in municipalities where the exposure rates of populationbased PSA screening have been lower than 5%. 3 In the mean time, mortality rates as a result of prostate cancer have increased and were estimated to be 9985 in 2008. 4 The number of deaths as a result of prostate cancer will reach 21 062 in 2020.5 Therefore, there is an urgent need to determine the best available countermeasures to decrease the rate of prostate cancer death. 2 The Cancer Countermeasure Fundamental Law, which is an important national policy in Japan declared in 2007, stated the goal of a 20% decrease in the mortality rates as a result of cancer in people aged below 75 years within 10 years. The JUA recommends PSA screening, which can lead to a decrease in the mortality rate of prostate cancer, based on well-balanced fact sheets in human dry-dock (Ningen dock) and also populationbased screening for prostate cancer to contribute to achieving the goal in terms of reducing the mortality rate of prostate cancer in all age ranges. 3 The latest results from the European Randomized Study of Screening for Prostate Cancer (ERSPC) showed that the mortality rate of prostate cancer showed a 20% and 31% decrease in the screening group compared with the control group during 9 years of observation on average by intention-to-screen (ITS) analysis 1 and a second analysis adjusted by compliance and contamination for the PSA test, 6 respectively. This study clearly s...

Assessment of Screenees' Knowledge on Prostate Cancer: Results of a Questionnaire Using the Fact Sheet

“…In other words, PSA was added to hematological parameters, and screening was continued. As the screening item is noninvasive in comparison with other cancer screenings, the number of self-governing bodies in which PSA screening was introduced increased 5-fold (71.2% of the cities/towns/villages of Japan according to a survey in 2006) during a 6-year period in Japan [4]. With the increase of PSA screening programs in our country, the propaganda ‘Early detection is the only way to save life' has been spread accordingly without the information of informed decision making.…”

“…Between 1995 and 2010, a total of 65,513 men (including repeated screenees) participated in this program, and prostate cancer was diagnosed in 520 men (0.8%). Between 2009 and 2010, we conducted the survey using Fact Sheet (table 1) after the primary screening [4] published by the Japanese Urological Association.…”

“…The importance of informed/shared decision-making has also been emphasized in Japan; the Fact Sheet before and after primary PSA testing was introduced in the ‘Guidelines for Prostate Cancer Screening in 2010' edited by the Japanese Urological Association [4]. In the Fact Sheet (table 1), the characteristics of prostate cancer in Japan, current status of PSA screening in Japan, advantages/disadvantages related to prostate biopsy procedure, and treatment-related complications are described.…”

Regional difference in cancer detection rate in prostate cancer screening by a local municipality in Japan

“…PSA-based screening systems for PCA have not been established by the Japanese government, but mostly administered by municipal governments since the 1990s. The Japanese Urological Association (JUA) recommends PSA-based screening for men over 50 years old, and also further examinations for patients with more than 4 ng/mL or age-adjusted cut off levels of PSA to assess the presence of PCAs [2]. Further examinations including digital rectal examinations, transrectal ultrasonography, blood examinations, magnetic resonance imaging, and/or prostate biopsy are performed as secondary screening.…”

Dihydrotestosterone synthesis pathways from inactive androgen 5α-androstane-3β,17β-diol in prostate cancer cells: Inhibition of intratumoural 3β-hydroxysteroid dehydrogenase activities by abiraterone

“…In Japan, PC will be the leading cause of cancer morbidity in the near future and the mortality rate of PC in 2020 is anticipated to be 2.8-fold higher than it was in 200012. Since Huggins and Hodges showed that surgical castration suppresses PC progression, it has been clear that androgen biosynthesis is important to the growth and survival of PC cells3.…”