A leadership opinion on prostate cancer “screening”

Two opinion-leaders behind the development and execution of the European Randomized Study of Screening for Prostate Cancer (ERSPC) have asked whether data from that trial and from the Prostate, Lung, Colorectal, and Ovarian Cancer (PLCO) screening trial have “resolved the controversy” about the need for mass, population-based “screening” for prostate cancer.

The article is written by Zhu, Roobol, and Schröder. Drs Roobol and Schröder are among the critical participants who helped to develop, implement, and interpret the results of the ERSPC trial in Europe. It is a little odd to see this article appearing in the less than widely-read journal Current Opinions in Supportive and Palliative Care, but maybe there’s an explanation for that too.

In this opinion piece, the authors make a series of initial points, as follows:

  • The ERSPC reported a statistically significant reduction in prostate cancer-specific mortality of 20 percent favoring screening in the intention-to-treat analysis and 31 percent in the secondary analysis.
  • The PLCO trial showed no reduction in prostate-cancer-specific mortality.
  • The PLCO trial should be considered as a comparison between a group of patients who were truly screened for prostate cancer and a second “less screened” group.

Given these initial points, the authors then make the following very specific statements and recommendations, based exclusively on the results of the ERSPC study:

  • There is not enough evidence (as yet) to introduce mass, population-based screening for prostate cancer in Europe.
  • Ongoing studies evaluating quality of life and cost-efficiency associated with early detection and treatment “need to be completed with the highest urgency.”
  • Data from these ongoing studies, together with more mature data from the ERSPC, will be required to reach a sound decision about the implementation of mass, population-based screening for prostate cancer.

They then make the following addition points:

  • We still need to improve the available screening test(s).
  • We still need a reliable, consistently applied screening protocol.
  • We still need an accurate, individualized risk assessment methodology if we are to decrease the rates of over-diagnosis and over-treatment.
  • Whatever else we do, we still need to maintain the gradual but ongoing reduction in the rate of prostate cancer-specific mortality and assure a high rate of detection of clinically significant prostate cancer.

It is easy to see what you want to believe in the words of others, but The “New” Prostate Cancer InfoLink finds it gratifying that Drs. Roobol and Schröder certainly appear to be endorsing a position taken by Prostate Cancer International and by Americas Prostate Cancer Organizations: that the critically important issue is the early detection of men with clinically significant forms of prostate cancer (i.e., the ones that present the highest risk for progressive and/or lethal disease) as opposed to the identification of every man with a prostate cancer cell in his biopsy specimen.

What they also appear to be saying is that our current tests and protocols may not good enough to justify mass, population-based screening for prostate cancer, and this is a point that The “New” Prostate Cancer InfoLink also agrees with. In saying this, we are not saying that people should stop PSA testing or that use of the PSA test is a bad idea. What we are saying is that we still need to do much, much better — and we think that’s what Zhu et al. are also suggesting in their article.

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