Screening of prostate cancer

Prostate cancer is one of the three major cancer sites in men; commonly occures after 50 years of age, with incidence progressively increasing in later decades of life. Only males with positive family history of a disease (at least one blood relative: father, grandfather, or brother) are at a higher risk even in age before 50 (American Cancer Society Guidelines for the Early Detection of Prostate Cancer, 2011; ESMO Guidelines Working Group, 2011).

Screening protocol include digitorectal examination (DRE) and PSA (prostate-specific-antigen) measuring in serum, in patients aged >50 years, in those who refer symptoms of prostatism and urinary tract disorders, or in those who require screening. The decision on whether or not to have a prostate biopsy (performed by transrectal ultrasound, TRUS) should take into account PSA parameters, such as free (f) PSA, fPSA/PSA ratio, DRE findings, prostate size, patient age, comorbidities, patient values and history of previous biopsy (American Cancer Society Guidelines for the Early Detection of Prostate Cancer, 2011; ESMO Guidelines Working Group, 2011).

Although there are evidence indicating that population-based screening may reduce prostate cancer mortality by approximately 20%, patients should have an opportunity to make an informed decision on whether to be screened or not, since there are some uncertainties associated with prostate cancer screening (American Cancer Society Guidelines for the Early Detection of Prostate Cancer, 2011; ESMO Guidelines Working Group, 2011). Namely, screening increases prostate cancer incidence, including subclinical forms that will not develop during life, leading to unnecessary manipulation and overtreating. Long prospective studies, and cost-effectiveness and quality of life analyses, which are now under way, are expected to justify decisions on population screening on prostate cancer.

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