Screening for prostate cancer has become more and more widespread fuelled by analogies with the “success” of breast cancer screening programmes.
But current research is asking what good screening actually does and whether it might not do more harm than good, in the form of increased worry due to abnormal tests results, discomfort from prostate biopsies, and the risks of incontinence, impotence and death from aggressive treatment.
This is particularly significant in light of inadequate research to show the benefit of curative treatments for early stage prostate cancer.
At the moment, even if prostate cancer can be diagnosed early, there is no way to definitively distinguish between those cancers destined to cause future morbidity and mortality and those which are not.
In related news, there is uncertainty about the true survival rate for those men who choose to have radical prostatectomies. Although one recent study has calculated that survival rates could be as high as 10 years (JAMA, 1996; 276: 615-9), this has been disputed as a fantasy figure given that the study only followed men for an average of four years after surgery.
In truth, survival seems to depend on the grade of tumour. Low grade tumours lead to longer term survival, whereas those with higher grade tumours have a dramatically decreased survival rate (JAMA, 1996; 276: 1723-4)
See WDDTY vol 6 no 4 for information on prostate cancer.