Prostate Cancer Screening – Pros and Cons

The results of a large-scale European study show that regular examinations of the prostate gland reduce the death rate from prostate cancer by more than 20%.

However, the authors emphasize that this approach also leads to a high level of overdiagnosis and therefore it is too early to introduce universal routine screening for prostate cancer by PSA test or prostate tumor markers.

Globally, prostate cancer is the second most common malignancy in men. In 2008, there were approximately 910,000 cases of prostate cancer worldwide, and experts estimate that 2030, men affected by this disease will almost double to 1.7 million people.

Prostate cancer very rarely occurs in men under the age of 40, but the risk of this disease significantly increases after the age of 50. 6 out of 10 cases of prostate cancer are in men over the age of 65.

Currently there is no routine screening program for prostate cancer, only a prostate specific antigen (PSA) test is available – this is a substance that the prostate secretes into the blood. Its high level it can be a symptom of the malignant disease of the prostate gland.

Prostate cancer screening recommendations vary between countries and even regionally.

For example, in the US, experts from the US Preventive Services Task Force advise men to examine their prostate only if they have symptoms.

And specialists from the American Cancer Society recommend that the representatives of the stronger sex over the age of 50 should contact their doctor to decide the question about the expediency of conducting such a screening.

There is also no national routine prostate cancer screening program in the UK. But there is a program to control the risk of malignant diseases of the prostate gland (Prostate Cancer Risk Management Programme).

It is mainly aimed at men who are concerned that they are at risk of developing prostate cancer, for example because of a family history.

In 1993, the European Randomized Study of Screening of Prostate Cancer (ERSPC) was launched. Its purpose was to investigate the question of the feasibility of introducing routine PSA tests for all men over a certain age.

In this study, the results of which were recently published in the journal The Lancet, more than 162,000 men between the ages of 50 and 74 from 8 European countries took part.

Participants were divided into 12 groups and every 4 years the first group was tested for prostate tumor markers, and the second group was not given any diagnostic methods. In Sweden, this screening was even carried out even every 2 years. Participants with a PSA level above 3 nanograms per milliliter of blood underwent a prostate biopsy.

During the 13-year study, 7,408 cases of prostate cancer were diagnosed in the screening group, and 6,107 cases in the other group.

The results of the first 9 years of the study showed that screening for prostate cancer reduced the death rate from this disease by 15%. By the 11th year since the start of the study, this ratio had risen to 22%. And further monitoring did not lead to a further decrease in prostate cancer mortality.

However, according to the study authors, it is too early to recommend the introduction of routine prostate cancer screening.

Researchers also note that overdiagnosis occurs in 40% of cases of prostate malignancy detected at screening.

And this can lead to unnecessary treatment and many side effects such as urinary incontinence and impotence.

According to the scientists, more research is needed in the first place to reduce the frequency of overdiagnosis and useless prostate biopsies.