Sharper criteria for early detection of prostate cancer
Some men benefit more from early detection of prostate cancer than others. Researchers at Erasmus MC have now discoverd for which group of men this applies which means that the criteria for screening and early diagnosis can be tightened.
Prostate cancer is the most common type of cancer occurring in men in the Netherlands. It particularly affects men aged 60 or older. Prostate cancer is the second most common cancer-related cause of death among men, after lung cancer. Early detection could reduce the number of prostate cancer related deaths by at least 20%. This so-called screening of prostate cancer does, however, also have disadvantages. In some men the prostate cancer develops at such a slow rate that they do not die as a result of prostate cancer but do die with prostate cancer. In some men the tumor remains so small that they experience no complaints. If the tumor in these men were to be detected early by screening, they would possibly be treated unnecessarily by means of radical surgery or radiation, including all its unpleasant consequences.
Pim van Leeuwen, physician and scientific researchers at the Erasmus MC’s Urology department: “Unlike previous studies we have been successful in identifying not only the groups of men who would relatively benefit most from screening and early detection, but also the men for whom the pros of screening and early detection do not appear to outweigh the cons.” In early detection of prostate cancer the so-called prostate specific antigen (PSA) is initially determined. In men aged between 55 and 74 with a low PSA value (between 0.1 and 1.9 ng/ml) the disadvantages of repeated screening appear to be substantially larger than the advantages. In this group 24,642 men would have to be examined in the course of the first nine years after the start of the screening to save one man from death from prostate cancer and 724 men would have to undergo treatment unnecessarily.
On the other hand, in men with a PSA value between 4 and 10 ng/ml or between 10 and 20 ng/ml the advantages of repeated screening appear to outweigh the disadvantages. In the latter group, only 133 men would need to be screened to prevent one death as a result of prostate cancer. Van Leeuwen: “On the basis of these results we can come to the conclusion that for the time being it would be advisable to exercise restraint in constantly re-examining men with a low PSA value. If this PSA limit is used properly, the balance between the pros and cons of screening and early diagnosis will improve. In this way we can prevent men having to undergo treatment that they actually do not require and would possibly only lead to adverse effects on the health of the patient as well as unnecessarily high healthcare costs.”
Date published: 13 September 2010