Prostate CancerThe Unintended Burden of Increased Prostate Cancer Detection Associated With Prostate Cancer Screening and Diagnosis
Section snippets
Trends in Prostate Cancer Diagnosis
Testing for PSA often leads to the early detection of prostate cancer. Unfortunately, because of its relatively high sensitivity and low specificity, the PSA test has caused many men to undergo a transrectal ultrasound and prostate biopsy. As a consequence, the introduction of PSA testing has increased the number of new cases dramatically. The effect of PSA testing on prostate cancer mortality is less clear.3 The recently reported Prostate, Lung, Colon and Ovarian (PLCO) trial reported no
Diagnosis- and Decision-Related Distress
The process of prostate cancer screening and performance of diagnostic procedures can have a negative effect on mental well-being. Men may experience anxiety throughout the screening process, with the wait for biopsy results being a particularly stressful event.18 A positive diagnosis can lead to further distress. For example, among 52 men who were enrolled in the ERSPC trial, mental health declined 1 month after diagnosis, returning to prediagnosis levels by 7 months.19
When given the news that
Effect of Prostate Cancer on a Patient's Family Members or Partner
Prostate cancer affects not only on the patient but also his close family members, particularly his spouse or partner, who may be his main source of support and who plays a significant role in the decision regarding treatment options.42 Research indicates that spouses may experience greater psychological and emotional distress than the patient.43 When considering treatment options, spouses may not place the same emphasis as patients on the potential QOL effect of treatment side effects. To
Potential Ways to Minimize the Unintended Consequences of PSA Testing
Advancing technology has enabled the detection of prostate cancer at an earlier stage, before clinical symptoms arise. This offers the opportunity to treat tumors earlier and the potential to reduce the mortality, morbidity, and deterioration of psychosocial function that are associated with advanced prostate cancer. However, repeated PSA testing has led to the diagnosis of a large number of small-volume low-grade cancers that may never become clinically relevant. This problem is destined to
Reducing the Risk of Prostate Cancer
The high prevalence and latent nature of most prostate cancers, and the significant morbidity and mortality associated with prostate cancer treatment, make it a suitable candidate for a risk-reduction strategy. A successful risk-reduction therapy would reduce both morbidity and mortality from this disease. Furthermore, it would decrease the number of men and their families burdened with diagnosis, facing treatment options, and living with the anxiety and adverse events associated with
Conclusions
Widespread testing for PSA has dramatically increased the number of men diagnosed with prostate cancer. The unintended consequence of this practice has been the increasing numbers of men diagnosed with small-volume, low-grade disease that in most cases is not clinically significant. The cost to the patient and society is significant. Men who have undergone primary screening because of an elevated PSA are at high risk of being diagnosed with prostate cancer and may benefit from drug therapy
Acknowledgments
The author thanks Choice Pharma (Hitchin, UK) for providing medical writing support during the preparation of this article, with the support of GlaxoSmithKline.
References (49)
- et al.
Prostate-cancer mortality in the USA and UK in 1975-2004: an ecological study
Lancet Oncol
(2008) - et al.
Contemporary trends in low risk prostate cancer: risk assessment and treatment
J Urol
(2007) - et al.
Prostate cancer diagnosis: the impact on patients' mental health
Eur J Cancer
(2006) - et al.
Continuing controversy over monitoring men with localized prostate cancer: a systematic review of programs in the prostate specific antigen era
J Urol
(2006) - et al.
An analysis of men with clinically localized prostate cancer who deferred definitive therapy
J Urol
(2004) - et al.
Quality of life before death for men with prostate cancer: results from the CaPSURE database
J Urol
(2001) - et al.
Brachytherapy versus prostatectomy in localized prostate cancer: results of a French multicenter prospective medico-economic study
Int J Radiat Oncol Biol Phys
(2007) - et al.
Delay in the progression of low-risk prostate cancer: rationale and design of the reduction by dutasteride of clinical progression events in expectant management (REDEEM) trial
Contemp Clin Trials
(2007) Chemoprevention of prostate cancer: agents and study designs
J Urol
(2007)- et al.
Chemoprevention of prostate cancer in men at high risk: rationale and design of the reduction by dutasteride of prostate cancer events (REDUCE) trial
J Urol
(2004)
Cancer Facts and Figures 2007
An assessment of the diagnosed prevalence of diseases in men 50 years of age or older
Am J Manag Care
Prostate-specific antigen and prostate cancer: prediction, detection and monitoring
Nat Rev Cancer
Prostate-specific antigen best practice statement: 2009 update
Guidelines for the Early Detection of Cancer
Screening for prostate cancer: U.S. Preventive Services Task Force recommendation statement
Ann Intern Med
PSA testing: public policy or private penchant?
J Am Med Assoc
Psychological adjustment of men with prostate cancer: a review of the literature
Biopsychosoc Med
Mortality results from a randomized prostate-cancer screening trial
N Engl J Med
Screening and prostate-cancer mortality in a randomized European study
N Engl J Med
Prostate cancer screening in the prostate, lung, colorectal and ovarian (PLCO) Cancer Screening Trial: findings from the initial screening round of a randomized trial
J Natl Cancer Inst
The influence of finasteride on the development of prostate cancer
N Engl J Med
Prostate-specific antigen: a review of the validation of the most commonly used cancer biomarker
Cancer
A decision analysis of alternative treatment strategies for clinically localized prostate cancerProstate Patient Outcomes Research Team
J Am Med Assoc
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