Our review of the published work is built on previous systematic reviews of prostate cancer screening, supplemented by an update of subsequent research from reviews and bibliographies of published articles and publications identified from major bibliographic sources, including Medline, Embase, and Web of Science, focusing on issues relating to MeSH terms “prostatic neoplasms” and “mass screening”, and text terms “prostate cancer” and “screening”.
SeriesScreening for prostate cancer
Section snippets
Judging the merits of screening
Discussions of screening are conventionally based on the criteria described by Wilson and Jungner.7 The enduring authority of that 1968 account partly reflects the value of its contents, but also the lack of fresh thinking since that time. This area of health policy is unsatisfactory in that support for, or dismissal of, the worth of screening programmes is dominated by advocacy rather than scientific debate. The recurrent confusion in screening policy relates to three aspects of the Wilson and
Epidemiology and natural history
The epidemiology of prostate cancer has been discussed by Henrik Grönberg earlier in this Lancet series.9 Here, we focus on those issues most relevant to screening: the importance of the disorder, the potential for primary prevention, and the extent to which the natural history of prostate cancer renders it amenable to screening.
Effectiveness of screening programmes
In the USA, the reported incidence and mortality of prostate cancer have risen and then fallen49 in ways that have been attributed to PSA screening and treatment changes.50, 51, 52 Similar trends have been seen in Austria.53, 54 In Quebec City, Canada, a 67% reduction in deaths was attributed to screening.55 How strong are these data in suggesting that screening affects mortality? Some of the assertions of effectiveness are naive. For example the findings of the Quebec trial55 are probably the
Conclusions
The balance of proof must be high to justify exposing men older than 50 years to a process where, of 1 million men, about 110 000 with raised PSAs will face anxiety over possible cancer, about 90 000 will undergo biopsy, and 20 000 will be diagnosed with cancer. If 10 000 of these men underwent surgery, about ten would die of the operation, 300 will develop severe urinary incontinence, and even in the best hands 4000 will become impotent. The number of men whose prostate cancer would have
Search strategy and selection criteria
References (82)
- et al.
Prostate cancer: to screen or not to screen?
Lancet Oncol
(2000) - et al.
American College of Preventive Medicine practice policy. Screening for prostate cancer in American men
Am J Prev Med
(1998) Prostate cancer epidemiology
Lancet
(2003)- et al.
A review of genetic polymorphisms and prostate cancer risk
Ann Epidemiol
(2002) - et al.
SELECT: the next prostate cancer prevention trial
J Urol
(2001) Localised prostate cancer: management and detection issues
Lancet
(1994)- et al.
Validity of the prostate specific antigen test for prostate cancer screening: follow-up study with a bank of 21 000 sera in Finland
J Urol
(2001) - et al.
Prostate cancer detection at low prostate specific antigen
J Urol
(2000) - et al.
The free-to-total prostate specific antigen ratio improves the specificity of prostate specific antigen in screening for prostate cancer in the general population
J Urol
(1997) - et al.
Natural history of localised prostatic cancer: a population-based study in 223 untreated patients
Lancet
(1989)
Prospective evaluation of men with stage T1c adenocarcinoma of the prostate
J Urol
Clinical decision-making in early prostate cancer
Lancet
Continence, potency and morbidity after radical perineal prostatectomy
J Urol
The development of erectile dysfunction in men treated for prostate cancer
J Urol
Prostate cancer screening in the Tyrol, Austria: experience and results
Eur J Cancer
Tyrol Prostate Cancer Screening Group. Prostate cancer mortality after introduction of prostate-specific antigen mass screening in the Federal State of Tyrol, Austria
Urology
Comparison of trends in prostate cancer mortality in England and Wales and the USA
Lancet
A comparison of cause of death determination in men previously diagnosed with prostate cancer who died in 1985 or 1995
J Urol
No randomised trial of prostate-cancer screening in Norway
Lancet Oncol
Prostate cancer screening: is it worth the pain?
San Francisco Chronicle
Advocates of PSA testing campaign to silence critics
BMJ
US Preventive Services Task Force. Guide to clinical preventive services
Prostate cancer: screening and early detection
Cancer Control
Principles and practice of screening for disease. Public Health Paper Number 34
Criteria for appraising the viability, effectiveness and appropriateness of a screening programme
Cancer burden in the year 2000: the global picture
Eur J Cancer
American Cancer Society guidelines for early detection of prostate cancer
Cancer
Office for National Statistics. 1993 Cancer statistics: registrations
Familial prostate cancer
Epidemiol Rev
Prostate Cancer Prevention Trial (PCPT) update
Eur Urol
Height, leg length and cancer risk: a systematic review
Epidemiol Rev
Insulin-like growth factors and prostate cancer
Epidemiol Rev
Epidemiology of prostate cancer
Urol Clin North Am
Screening for prostate cancer: estimating the magnitude of overdetection
Can Med Assoc J
Screening for prostate cancer: evidence and perspectives
BJU Int
Competing risk analysis of men aged 55–74 years at diagnosis managed conservatively for clinically localized prostate cancer
JAMA
Quality improvement report: Improving design and conduct of randomised trials by embedding them in qualitative research: ProtecT (prostate testing for cancer and treatment) study
BMJ
Surgery and the reduction of mortality from prostate cancer
N Engl J Med
Long-term survival among men with conservatively treated localized prostate cancer
JAMA
PSA-based screening for prostate cancer in asymptomatic younger males: pilot study in blood donors
Prostate
European randomised study of prostate cancer screening: first-year results of the Finnish trial
Br J Cancer
Cited by (173)
[Mn(PaPy2Q)(NO)]ClO<inf>4</inf>, a Near-Infrared Light activated release of Nitric Oxide drug as a nitric oxide donor for therapy of human prostate cancer cells in vitro and in vivo
2021, Biomedicine and PharmacotherapyCitation Excerpt :Prostate cancer (PCa) is one of the most common cancers in men [1]. The incidence rate of PCa in China had gradually increased with ageing population and the improvement of living conditions in the last 20 years, and its incidence had ranked 3rd among male genitourinary malignancies [2]. PCa is characterized by complex etiology, hidden site, long latency period, and diverse pathological features.
Determination of oncourological pathologies based on the analysis of medical images using machine learning methods
2023, Recent Advancements in Multimedia Data Processing and Security: Issues, Challenges, and TechniquesNo association between MTHFR gene C677T/A1298C polymorphisms, serum folate, vitamin B12, homocysteine levels, and prostate cancer in an Algerian population
2023, Molecular Genetics and Genomic Medicine