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Medicas UIS

Print version ISSN 0121-0319

Medicas UIS vol.29 no.3 Bucaramanga Sep./Dec. 2016

 

Carta al Editor

The controversial screening for prostate cancer

El cribado controversial para cáncer de próstata

Sebastián Concha *  

Eva Madrid **  

1* 7th level Medical Student. School of Medicine. Universidad de Valparaíso. Valparaíso. Chile.

2** MD. PhD. Department of Public Health. Biomedical Research Centre. School of Medicine. Universidad de Valparaíso. Valparaíso. Chile.


Prostate Cancer (PC) is the worldwide most frequent neoplasm among males1, with the highest incidence rates in North America, Australia, New Zealand and Western Europe2. Most of the cases display a slow and asymptomatic growth3,4, and are mainly detected at medical routine controls in males over 65 years5. Screening programs have been developed in order to reduce prostate cancer-specific mortality and to enhance patients’ quality of life. However, its effectiveness has caused a lot of controversy, and a permanent debate within the medical community. In this line, different recommendations have been issued by medical and government organizations.

The use of prostate-specific antigen as a marker, a cornerstone of PC detection during last decades6, has remained under discussion due to the uncertainty surrounding its benefits, risks and optimal strategy of prescription7. On the other hand, screening necessarily implies overdiagnosis and overtreatment8, which turn into negative aspects when considering that many cases of PC will present a low morbidity related to the illness and will remain in low grade stages for years9. Furthermore, a great proportion of patients suffering from the illness will never be diagnosed and will die due to another cause3,4.

To date, there is enough evidence that support the fact that PC diagnosis is higher in screened patients8-9-10, mainly localized PC and, with a lower proportion, those who are in advanced stages. Nevertheless, a Cochrane systematic review found that PC screening has not reduced global or specific mortality globally8.

Undoubtedly, it is of utmost relevance to optimize screening methods in PC. Enhancement of prostatespecific antigenusage and the growing evidence about recently discovered tumor markers, are promissory tools that might decrease the implications of overdiagnosis, allowing to distinguish patients with asymptomatic PC from those who will need a more aggressive management11. Thus, the aftermath derived from the curative treatment might be avoided12 when taking into account that screening has increased the localized PC diagnosis8. Meanwhile, clinical decisions should be guided by the best available evidence

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10. Hayes JH, Barry MJ. Screening for prostate cancer with the prostate-specific antigen test: a review of current evidence. JAMA. 2014;311(11):1143-9. [ Links ]

11. Cuzick, J, Thorat MA, Andriole G, Brawley OW, Brown PH, Culig Z, et al., Prevention and early detection of prostate cancer. Lancet Oncol. 2014;15(11): e484-92. [ Links ]

12. Draisma G, Boer R, Otto SJ, van de Crujisen IW, Damhuis RA, Schrôder FH, et al. Lead times and overdetection due to prostatespecific antigen screening: estimates from the European Randomized Study of Screening for Prostate Cancer. J Natl Cancer Inst. 2003;95(12):868-78 [ Links ]

Received: October 01, 2016; Accepted: November 20, 2016

Corresponding Author: Eva Madrid Aris, MD, PhD, Department of Public Health, School of Medicine, Faculty of Medicine, Universidad de Valparaíso, Valparaíso, Chile. Angamos 655, Viña del Mar - Chile. E-mail: eva.madrid@uv.cl. MÉD.UIS. 2016;29(3): 7.

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