Prostate Cancer Screening

The aim of the European Randomized Prostate Cancer Screening Trial (ERSPC), conducted from 1993 to 2014 and involving more than 162,000 subjects, was to determine the role of regular prostate-specific antigen (PSA) blood testing in reducing prostate cancer mortality.

Subjects aged 50 to 74 years from eight countries (Belgium, Finland, France, Italy, the Netherlands, Spain, Sweden and Switzerland) were randomized into 2 groups: subjects in group 1 underwent PSA screening every 4 years (in Sweden - every 2 years), Group 2 It was a control group (no examination was conducted). If the PSA concentration exceeded 3 ng/ml, the men were referred for prostate biopsy.

The results of the study showed that in the group with regular screening prostate cancer mortality was 15% lower during 9 years compared with the control group, and 22% lower during 11 years. With longer follow-up, no further increase in survival rates was detected in group 1. Thus, the mortality rate from prostate cancer among patients who underwent a screening study, PSA levels were reduced by approximately 1/5 when compared with the control group.

Despite new evidence in favor of the effectiveness of PSA screening in reducing mortality from prostate cancer, doubts remain whether the benefits of screening outweigh the possible harms of overdiagnosis associated with it. Scientists conclude that at the moment it is worth refraining from introducing such screening programs.

According to a study by Professor Fritz Schröder from the Erasmus University Medical Center in the Netherlands, who is the first author of the published article, PSA screening provides a significant reduction in prostate cancer deaths, with similar or higher rates than breast cancer screening. However, in about 40% of screening cases, we are dealing with overdiagnosis, leading to a high risk of overtreatment and side effects such as urinary incontinence and impotence.

He adds: "The time has not yet come for full-fledged screening in the general population. There is an urgent need for further research aimed at reducing overdiagnosis by reducing unnecessary biopsies and reducing the number of men who need to undergo screening, biopsy and treatment."

One of the promising approaches, according to Professor Schroeder, is multiparametric MRI, which in some cases makes it possible to differentially diagnose prostate cancer, which is characterized by aggressive growth, and many "not so significant" tumors, which usually grow so slowly that most patients with their presence, people die from other causes. At the moment, the professor believes, well-thought-out and balanced information about the possible harm of screening overdiagnosis and, as a result, hypertreatment should be conveyed to the male population.

Ian Thompson from the University of Texas HSC, San Antonio, USA and Catherine Tangen from the Fred Hutchinson Cancer Research Center, Seattle, USA, discuss possible ways to mitigate the disadvantages of screening. They believe that "the new results of the European Randomized Prostate Cancer Screening Trial (ERSPC) are significant." Studying the distribution of prostate cancer deaths depending on the Gleason scale and PSA levels is very important for correcting and adapting screening and treatment programs.

Prostate cancer screening is a regular (once a year or every 2 years) examination by a urologist, during which a blood test for prostate-specific antigen (PSA) and a finger rectal examination are performed.

The problem of prostate cancer screening has been widely discussed around the world for 10 years. The fact is that prostate cancer screening has been conducted since the late 80s and early 90s. Over the years, both positive and negative screening results have been accumulated. The positive result includes a reduction in prostate cancer mortality by an average of 20% in all developed Western countries. The negative result of prostate cancer screening can be attributed to unnecessary surgeries in patients who will never die from this disease, since they are in the age group (over 70 years old) when they have prostate cancer will not cause death. This is usually due to the fact that the cancer they have is not aggressive enough and will not have time to metastasize in their lifetime. Such patients do not need to be operated on.

If we talk about government screening programs that have been adopted in Western European countries and the United States, then large contingents of the male population are being examined there - more than 60%. With such mass examinations, patients are identified there, 70% of whom have cancer in a still curable stage, and 30% have incurable cancer. In our country, 65-70% of prostate cancer cases are still locally advanced or metastatic, when the patient can no longer be cured. And very often we have to deal with cases of death of young men, sometimes younger than 50 years old, from prostate cancer.

Therefore, it is premature to talk about the dangers of screening in Russia, since we did not have it in sufficient volume. In the West, if a person is included in a government screening program, their disease is much less likely to progress to an incurable stage, and will be detected at an early stage. At the same time, he may have an extra biopsy, for example, and he may undergo unnecessary treatment. In any case, the inclusion of cancer in the screening program is an individual decision of the patient. In a European Medical Center, for example, all procedures are performed only after receiving informed consent from the patient, which he signs after receiving comprehensive information about the program from the doctor. And we believe that the inclusion of men over the age of 45 in the prostate cancer screening program has much more benefits than potential harm, and we strongly recommend this to our patients.

We remind you that the EMC has an early diagnosis program for dangerous diseases.