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Related Experiment Videos

Screening and early detection of prostate cancer will decrease morbidity and mortality from prostate cancer: the

R R Hall1

  • 1Department of Urology, Freeman Hospital, Newcastle-upon-Tyne, UK.

European Urology
|January 1, 1996
PubMed
Summary

Early prostate cancer detection using PSA, DRE, and ultrasound is common, but its benefits are uncertain. More research is needed to determine if treating these cancers truly reduces mortality or morbidity.

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Area of Science:

  • Urology
  • Oncology
  • Public Health

Background:

  • Prostate specific antigen (PSA), digital rectal examination (DRE), and transurethral ultrasound are established methods for detecting prostate cancer.
  • Early detection programs identify prostate cancer in 6% of men over 50, often as stage T1c (confined to the prostate).
  • The clinical significance and optimal management of screen-detected, clinically insignificant prostate cancers remain debated.

Purpose of the Study:

  • To evaluate the certainty of reduced mortality and morbidity from treating early-stage, screen-detected prostate cancers.
  • To highlight the lack of long-term outcome data for stage T1c prostate cancer.
  • To question the established prostate-specific antigen (PSA) thresholds and biopsy findings in relation to prostate cancer death.

Main Methods:

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  • Review of available statistics on prostate cancer incidence, mortality, and treatment outcomes.
  • Analysis of the potential benefits versus harms of screening, biopsy, and treatment for prostate cancer.
  • Identification of knowledge gaps regarding the long-term prognosis of T1c prostate cancer.

Main Results:

  • The lifetime incidence of screen-detected prostate cancers may exceed the likelihood of dying from the disease.
  • The operative mortality of prostatectomy and the morbidity associated with screening, biopsy, and treatment raise doubts about overall benefit.
  • Crucial data on long-term outcomes for T1c prostate cancer and the impact of PSA levels/biopsy results on mortality are missing.

Conclusions:

  • The net benefit of current prostate cancer early detection strategies in reducing mortality and morbidity is uncertain.
  • Prospective randomized trials are essential to provide scientifically based information on mortality, quality of life, and cost-effectiveness.
  • Evidence-based decision-making is crucial before widespread adoption of prostate cancer screening, particularly for European populations.