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

By:
Contributors: Bryan Donnelly, MD, MSc, FRCSC, Dean Ruether, MD FRCSC, Michael Chetner, MD, MSc, FRCSC, FACS, Peter Venner, MD, FRCPC
Can Urol Assoc J. 2011 Dec;5(6):416-21. doi: 10.5489/cuaj.11063.

Abstract

Screening for prostate cancer remains a contentious issue. As with other cancer screening programs, a key feature of the debate is verification of cancerspecific 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 colorectal cancer. However, the risks associated with prostate cancer screening are considerable and must be weighed against the advantage of reduced cancerspecific 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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APCaRI is part of the Movember Prostate Cancer Outcomes network

The Prostate Cancer Outcomes Global Initiative to Compare and Reduce Variation is a project led by Movember aiming to improve health outcomes for men throughout their prostate cancer journey by focusing on variation in care and engaging clinicians and researchers across 14 countries worldwide.

The international team will collect data from prostate cancer patients segmented into the categories of data items as outlined by the International Consortium for Health Outcomes Measurement (ICHOM). These include patient factors, baseline tumor factors, pathological information, treatment variables, acute complications of treatment, and survival and disease control).

The Alberta Prostate Cancer dataset is highly aligned with the ICHOM standards. This means that we can effectively compare treatments and outcomes in Alberta with teams around the world to find ways to improve our care at home and abroad!

This is the result of hours of planning and true team work lead by Dr. Trafford Crump, the APCaRI Scientific and Data Quality Committee, and the APCaRI clinical, scientific, research and pathology teams. Thanks to your efforts, we are one step closer to improving patient outcomes.

- John Lewis