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Screening for prostate cancer
Last reviewed: 18.10.2021
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In all countries, screening for prostate cancer remains relevant. Data on the reduction in mortality due to the use of screening are contradictory. Since the organization of screening studies requires significant financial costs, it is necessary to preliminarily resolve questions about the age at which screening examinations start and stop and the timing of repeated examinations.
The goal of prostate cancer screening is to reduce cancer mortality by early detection of tumors. Early diagnosis is carried out using mass or individual examinations. The indicator of the effectiveness of screening is the reduction of mortality from prostate cancer and the provision of a high quality of life. Detection of tumors and an increase in survival rate can not serve as such an indicator, since very early diagnosis contributes to an increase in survival (the effect of advancing).
The dynamics of mortality from prostate cancer in developed countries is different. In the United States, Britain, France and Austria, its decline occurs at approximately the same rate. The decline in mortality observed in recent years in the US is often explained by mass surveys (based on the definition of prostate-specific antigen), but there is as yet no definitive confirmation of this.
The value of screening for prostate cancer is confirmed by research in Tyrol (Austria). After the introduction of an early detection program and free treatment for prostate cancer, the death rate from it decreased 33% faster than in the rest of Austria. A randomized trial in Quebec (Canada) also showed a reduction in mortality as a result of early diagnosis. Comparison of deaths from prostate cancer in Seattle, where mass surveys were conducted, and Connecticut, where none existed, showed no significant differences, although Seattle residents were regularly diagnosed with prostate-specific antigen (PSA) and were much more likely to receive radical treatment. To determine the effectiveness of screening, large randomized trials should be carried out. Two such tests take place in the US and Europe; the first results are expected in 2008.
Thus, in order to recommend mass screening for prostate cancer screening, the data is not enough. The American and European associations of urologists recommend that all men over the age of 50 have a PSA level and a digital rectal examination. Only 8% of African Americans aged 40-50 years with hereditary predisposition, found a pathology at the examination, but in 55% of them the diagnosis of prostate cancer was confirmed. That is why all patients who are at risk, after 40 years, should undergo an urological examination every year.
In economically developed countries, awareness of the population about prostate cancer has been raised to a high level and most men independently consult a doctor of any specialty to determine the level of PSA. In Russia, onkostorozhennost extremely low, so there is an objective need to create a system of informing potential patients and promoting screening for prostate cancer (local press, television).
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