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Stopping screening, when and how?

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  • 1Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.

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Summary
This summary is machine-generated.

Prostate cancer screening benefits decrease with age due to over-diagnosis risks. More research is needed on screening older men to balance harms and benefits, especially for those over 70.

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Area of Science:

  • Urology
  • Oncology
  • Public Health

Background:

  • Prostate cancer (PC) screening remains controversial despite evidence of reduced mortality.
  • Over-diagnosis of indolent cancers and associated harms are significant concerns, particularly in older men.
  • Current screening methods, including prostate-specific antigen (PSA) testing and blind biopsy, contribute to over-diagnosis.

Purpose of the Study:

  • To evaluate the age at which the harms of prostate cancer screening outweigh the benefits.
  • To analyze the trade-offs between screening older men and the risk of over-diagnosis and treatment complications.
  • To discuss the implications of screening cessation on long-term prostate cancer mortality.

Main Methods:

  • Review of randomized controlled trials, including the European Randomised Study of Screening for Prostate Cancer (ERSPC).
  • Analysis of modeling studies on quality-adjusted life-years (QALYs) gained from screening at different ages.
  • Consideration of PC mortality trends and the duration of screening effects.

Main Results:

  • While PC mortality decreases with screening, over-diagnosis is prevalent, especially in men over 70.
  • Quality-adjusted life-years (QALYs) gained from screening decrease after age 65-70, though remain positive up to 75.
  • Prostate cancer mortality rates in screened groups converge with control groups approximately 10 years after screening cessation.

Conclusions:

  • Screening older men (e.g., >70) with limited life expectancy warrants careful consideration due to potential harms exceeding benefits.
  • Further research is needed to better evaluate the age-specific balance of harms and benefits, including treatment side-effects and costs.
  • Development of more specific screening markers and imaging techniques is crucial to reduce over-diagnosis in elderly populations.