Early detection of prostate cancer. What do we tell our patients?

Early detection of prostate cancer is possible; overdetection of early disease that may never surface clinically during a lifetime is likely. On the other hand, early detection measures will detect life-threatening disease of which some maybe amenable to cure, while otherwise it would kill the patient. Proof of effectiveness of early detection is unavailable. Those who decide to be screened and those who decide not to be screened take risks that are difficult to balance against each other. How do we deal with this situation? What do we tell our patients?

Ongoing randomized studies are likely to produce definitive answers on the question of whether screening will save men from prostate cancer deaths within a few years. The trials will also provide answers to the optimal way of screening and to the question of how to avoid overdiagnosis and treatment. In the meantime, however, men who are considering to undergo testing have a difficult decision to make. Our profession is obliged to provide assistance. The information provided unfortunately at this time cannot be the simple message: if you undergo testing your cancer will be detected early and be curable, so you will resolve the problem. It is necessary to stress the potential benefits and also the downside of testing. Elements of such information are provided in this article. Benefits may include the reassurance resulting from a normal test result, the early diagnosis of aggressive and still-curable cancer, and the avoidance of the consequences of advanced prostate cancer such as the occurrence of metastatic disease. The downside includes the possibility of missing prostate cancer and providing a false reassurance, the fact that screening may lead to unnecessary anxiety and medical tests when no cancer is present, and the fact that it may detect slow-growing cancer that may never cause any symptoms or shorten lifespan. All treatments have side effects to which men will be exposed, even those who do not have life-threatening cancer. In addition, there is no certainty that treatment will be successful.

In the present situation, it is important to emphasize to patients that capabilities are being developed to identify those prostate cancers that may not cause any harm and to exclude them from immediate treatment. This recent development is a very important aspect for those who consider to be tested outside ongoing trials.