To elaborate on prostate cancer screening
"Two large randomised studies tested whether
screening reduces prostate cancer mortality and, while
the US trial reported no benefit,1
the European (ERSPC)
trial noted a significant reduction in mortality.2"
"In The Lancet, Fritz Schroder and colleagues3
now report 13-year mortality data from the ERSPC study.
At 9 years, screening appeared to reduce prostate cancer
mortality by 15% (rate ratio 0·85, 95% CI 0·70–1·03);
this reduction was 22% at 11 years (0·78, 0·66–0·91)
and 21% at 13 years (0·79, 0·69–0·91). Importantly,
the number needed to invite to be screened to prevent
one death fell from 1410 at 9 years to 781 at 13 years;
the number needed to detect cancer fell from 48 to 27,
showing continued improvement in the absolute effect
of screening."
"Despite this finding, present prostate-specific
antigen (PSA)-based screening is imperfect."
"It is this trio of drawbacks (overdetection,
treatment complications, and disease progression) that
leads to the uncertainty about the role of screening."
"An improved understanding of prostate cancer might
tip the balance towards increased use of screening."
"If most of the patients with low-risk prostate cancer in the
ERSPC intervention group (60% of all the cancers diagnosed)
were managed with active surveillance, the side-effects of treatment
would be substantially reduced."
"To further mitigate the disadvantages of screening, it is
now possible to use screening results to counsel patients
who would generally receive a biopsy recommendation
regarding their individual trade-off s of prostate
biopsy: a potential benefit of detection of high-grade
cancer, allowing for treatment and reduction in risk
of cancer death versus a potential risk of detection of
low-grade cancers that are most commonly indolent,
for which treatment has few benefits but considerable
potential side-effects"
"We have noted that, when such information is provided
to patients, fewer men who are apt to be overdetected
will choose biopsy. This information, coupled with new
biomarkers that are focused on detection of potentially
lethal disease, improves the benefit–risk ratio of prostate
cancer screening."
"Because the median follow-up from diagnosis of
prostate cancer was 6·4 years for the intervention group
and 4·3 years in the control group, and because high-risk
disease often requires 12–15 years to cause death,
we would not be surprised if the benefit of screening
becomes more apparent with longer follow-up."
To quickly resume, the benefit of PSA screening may become more apparent with time and disadvantages of screening may be reduced by undertaking certain measures (active surveillance, no biopsies with low risk factors) so that benefits of screening may outweigh drawbacks. So, conclusions by these task forces may be indeed too quickly drawn up.
For these and other reasons mentioned above, I still think it would be in our best interest to do screening, after the age of 60 (when prostate cancers have been found in transsexual women), perhaps even before, after age 50, to be on the safe side, as the majority of prostate cancers in men occurs after this age.
