Prostate cancer screening - is it time to change approach?

Area of Science:

• Urology
• Oncology
• Public Health

Background:

• Prostate adenocarcinoma (CaP) is a leading malignancy in men globally and in Slovakia, accounting for over 22% of male tumors.
• Current screening practices increase CaP diagnosis rates but have not demonstrably improved overall or CaP-specific mortality.
• Early detection is crucial for managing CaP, particularly high-risk forms, to enhance quality of life.

Purpose of the Study:

• To evaluate the incidence of prostate adenocarcinoma (CaP) in patients examined and treated at the Railway Hospital (RH) in Košice from 2014 to 2019.
• To assess the associated risks and available treatment options for diagnosed CaP cases.
• To analyze the effectiveness of preventive examinations in early CaP detection.

Main Methods:

• A cohort of 3,943 men aged 40-75 underwent preventive examinations at the RH urology outpatient clinic between 2014-2019.
• Data collected included epidemiological parameters, prostate-specific antigen (PSA) levels, digital rectal examinations (DRE), ultrasonography, and biopsy results.
• Prostate cancer incidence, PSA value correlations, risk classification (based on PSA and histology), and initial treatments were monitored.

Main Results:

• Of the patients who underwent biopsy, PSA values ranged from 3.6 to 2,000 ng/mL.
• Positive digital rectal examinations were noted in 52 patients.
• Prostate biopsies confirmed CaP in 231 patients (61.28%), while 146 (38.72%) had benign prostatic hyperplasia or chronic prostatitis. Risk stratification identified 109 low-risk, 57 medium-risk, and 24 high-risk CaP cases.

Conclusions:

• Preventive screening can detect prostate cancer approximately 10 years before clinical manifestation.
• The primary goal of preventive examinations should be identifying early-stage, high-risk prostate cancer to improve men's quality of life.
• Continued active surveillance for prostate cancer is essential to reduce the incidence of metastatic disease.