Prostate cancer screening update

The question of  the utility of screening for prostate cancer in men with PSA testing continues to fuel debate.  A recent New England Journal of Medicine article gives a nice summary in this regard (see link below).  With regard to PSA screening for prostate cancer, 1 study (ERSPC) showed that checking PSA every for years versus not checking at all confers a mortality benefit on those aged 55-69 (not for those under 55 or 70 and older).  A second PSA screening study (PLCO) showed that checking PSA every year for 6 years conferred no mortality benefit in those men aged 55-74.  In regards to treatment, the Scandinavian Prostate Study Group compared radical prostatectomy with observation in those men diagnosed with prostate cancer and found a mortality reduction with surgery in men 65 and younger.  In a second treatment trial (Prostate Cancer Intervention vs Observation trial), radical prostatectomy was compared with observation and no benefit was found in those with “lower risk” (presumably Gleason score <6) cancers and a marginal benefit in “higher risk” cancers.  Other treatment trials have shown that EBRT (External Beam Radiation Therapy) and androgen deprivation therapy confer a survival benefit if the cancer has a Gleason score > 6.  The take home message is that both screening for and treating prostate cancer is a process that has to take into account the individual preferences and risk factors of each individual patient.  The screening and treatment decision is not an absolute yes or no, but an informed decision formed in discussion with ones physician.


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