Furthering the prostate cancer screening debate (prostate cancer specific mortality and associated risks)

Authors

  • G. Michael Allan Department of Family Medicine, University of Alberta, Edmonton, AB
  • Michael P. Chetner Department of Surgery, Faculty of Medicine, University of Alberta, Edmonton
  • Bryan J. Donnelly Prostate Cancer Centre, Calgary, AB
  • Neil A. Hagen Departments of Oncology, Clinical Neurosciences and Medicine, University of Calgary, Calgary, AB
  • David Ross Department of Family Medicine, University of Alberta, Edmonton, AB
  • J. Dean Ruether Department of Medical Oncology, University of Calgary, Calgary, AB
  • Peter Venner Department of Medical Oncology, Cross Cancer Institute, & Division of Medical Oncology, Department of Oncology, University of Alberta, Edmonton, AB

DOI:

https://doi.org/10.5489/cuaj.733

Abstract

Screening for prostate cancer remains a contentious issue. As with
other cancer screening programs, a key feature of the debate is
verification of cancer-specific mortality reductions. Unfortunately
the present evidence, two systematic reviews and six randomized
controlled trials, have reported conflicting results. Furthermore, half
of the studies are poor quality and the evidence is clouded by key
weaknesses, including poor adherence to screening in the intervention
arm or high rates of screening in the control arm. In high
quality studies of prostate cancer screening (particularly prostatespecific
antigen), in which actual compliance was anticipated in
the study design, there is good evidence that prostate cancer mortality
is reduced. The numbers needed to screen are at least as good
as those of mammography for breast cancer and fecal occult blood
testing for colo-rectal cancer. However, the risks associated with
prostate cancer screening are considerable and must be weighed
against the advantage of reduced cancer-specific mortality. Adverse
events include 70% rate of false positives, important risks associated
with prostate biopsy, and the serious consequences of prostate
cancer treatment. The best evidence demonstrates prostate cancer
screening will reduce prostate cancer mortality. It is time for the
debate to move beyond this issue, and begin a well-informed discussion
on the remaining complex issues associated with prostate
cancer screening and appropriate management.

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Author Biographies

G. Michael Allan, Department of Family Medicine, University of Alberta, Edmonton, AB

Michael P. Chetner, Department of Surgery, Faculty of Medicine, University of Alberta, Edmonton

Bryan J. Donnelly, Prostate Cancer Centre, Calgary, AB

Neil A. Hagen, Departments of Oncology, Clinical Neurosciences and Medicine, University of Calgary, Calgary, AB

David Ross, Department of Family Medicine, University of Alberta, Edmonton, AB

J. Dean Ruether, Department of Medical Oncology, University of Calgary, Calgary, AB

Peter Venner, Department of Medical Oncology, Cross Cancer Institute, & Division of Medical Oncology, Department of Oncology, University of Alberta, Edmonton, AB

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How to Cite

Allan, G. M., Chetner, M. P., Donnelly, B. J., Hagen, N. A., Ross, D., Ruether, J. D., & Venner, P. (2013). Furthering the prostate cancer screening debate (prostate cancer specific mortality and associated risks). Canadian Urological Association Journal, 5(6), 416–21. https://doi.org/10.5489/cuaj.733

Issue

Section

Review