Volume 199 - Issue 9
The dilemmas of prostate cancer screening
Author: Ian E Haines
Med J Aust 2013; 199 (9): 582-583. || doi: 10.5694/mja13.10833
Published online: 4 November 2013
Published online: 4 November 2013
To the Editor: Recent articles in the Journal evaluating the evidence
on screening for early-stage prostate cancer1,2 failed to mention one of the most important pieces of evidence ever published on the treatment of prostate cancer.3 This randomised controlled trial (RCT) showed that, compared with observation, radical prostatectomy
did not significantly reduce all-cause
or prostate cancer mortality over at least 12 years among men with clinically ...
To the Editor: Recent articles in the Journal evaluating the evidence on screening for early-stage prostate cancer1,2 failed to mention one of the most important pieces of evidence ever published on the treatment of prostate cancer.3 This randomised controlled trial (RCT) showed that, compared with observation, radical prostatectomy did not significantly reduce all-cause or prostate cancer mortality over at least 12 years among men with clinically localised prostate cancer diagnosed in the era of prostate-specific antigen (PSA) testing.3
The underlying premise of performing screening trials to detect cancers at an earlier stage is that the treatment given to the increased number of patients diagnosed with early-stage disease will cure or benefit more patients than no treatment at all. While this is true for surgery for bowel cancer, it has not been proven for radical treatment, particularly prostatectomy, for early-stage prostate cancer. In spite of this fact, there has recently been a stage migration towards earlier diagnosis in Victoria, and a large increase in the use of radical prostatectomy among men with clinically localised disease.4
Hugosson and Carlsson conclude by stating, very reasonably, that men facing a decision about PSA screening should be given written information about the best evidence available today.2 Surely this evidence should include that, in the PSA-testing era, the only RCT of the surgical treatment recommended to many of these men has shown that this treatment is no better than no treatment, and that it also causes significant morbidity?
Competing interests
No relevant disclosures.
References
- Del Mar CB, Glasziou PP, Hirst GH, et al. Should we screen for prostate cancer? A re-examination of the evidence. Med J Aust 2013; 198: 525-527. 0_BABICEHF
- Hugosson J, Carlsson SV. The dilemmas of prostate cancer screening. Med J Aust 2013; 198: 528-529. 0_CBBCJHCE
- Wilt TJ, Brawer MK, Jones KM, et al. Radical prostatectomy versus observation for localized prostate cancer. N Engl J Med 2012; 367: 203-213. 0_pgfId-2887059
- Evans SM, Millar JL, Davis ID, et al. Patterns of care for men diagnosed with prostate cancer in Victoria from 2008 to 2011. Med J Aust 2013; 198: 540-545. 0_i1142878