Update on Screening in Prostate Cancer Based on Recent Clinical Trials

Alessandro      Sciarra; Susanna      Cattarino; Stefano      Salciccia; Alessandro      Gentilucci; Andrea      Alfarone; Gianna      Mariotti; Michele      Innocenzi; Vincenzo      Gentile

doi:10.2174/157488711793980165

Abstract

Introduction and Aim: Prostate cancer (Pc) is a major public health problem, affecting 679,000 men and causing 221,000 deaths every year. Over the past decade, there has been a marked decline in Pc mortality corresponding to the introduction of prostate specific antigen (PSA) test as a screening tool (1986). Despite this clear result, the screening recommendations of various organizations differ. Recently, a large number of studies have highlighted the benefits and risks of PSA based screening. The aim of this article is to review the current screening guidelines and summarise the benefits and harms of PSA testing, analysing two large long awaited randomized multicenter clinical trials of PSA screening reported this year. Methods for the Review: We reviewed the recent literature using PUBMED research, using as words for research: Prostate- Specific Antigen, mass screening, Prostatic neoplasm mortality, follow-up studies, overdiagnosis and overtreatment. In particular, we analysed two clinical trials reported on “ The New England Journal of Medicine” this year: the European Randomized Study of Screening for Prostate Cancer (ERSPC) by Scroeder et al. and the U.S. Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial by Andriole et al. Results and Conclusions: The goal of a screening is to detect a cancer at an early stage, when it is still curable. In Pc case there are different treatments with curative intent, that are associated with significant morbidity. Some man have an aggressive form for which screening might be helpful but many have a slow growing cancer that would never progress and their detection could cause anxiety and bring unnecessary medical treatment. With this review we tried to understand where we should stop the management: Overdiagnosis or Overtreatment?

Keywords: Prostate neoplasm, screening, prostate specific antigen, European Randomized Study of Screening for Prostate Cancer, PLCO, digital rectal examination, lower urinary tract symptoms, proliferation inflammatory atrophy, PLCO Trial, DRE, Radical prostatectomy, radiotherapy, hormone therapy