Prostate cancer screening
Unacceptable in the under 50s
BMJ 15 Decembre 2007 | Volume 335
Par aimable autorisation des auteurs Dr A. Braillon - Dr G. Dubois
Lane et al report the feasibility of testing for prostate cancer in men aged 45-49.1
Screening for prostate cancer in men older than 50 is hardly acceptable because overdiagnosis is obvious and the impact on mortality remains unproved despite numerous trials in the past 15 years.
Of 19 major medical organisations worldwide, only the American Cancer Society and the French and American urological associations recommend screening men for prostate cancer with annual measurement of prostate specific antigen (PSA).2 Therefore, in addition to wasting resources, the paper by Lane et al will be used to promote screening.1 In France 36% of men underwent prostate cancer screening (unproved and not organised), whereas only 25% underwent colorectal cancer screening (proved benefit on mortality and organised).3 The only demonstrated effect of prostate cancer screening is a 5-10% biopsy rate in the screened population, with a risk of septicaemia and haemorrhage. Plus, for those treated, various adverse effects (impotence, incontinence, pain, rectal ulcers, etc).
The recommendation from the American National Comprehensive Cancer Network for screening for PSA in men from age 40 cited by Lane et al to support their hypothesis is a view from a single department of urology. The guideline is a summary of the pros and cons and describes screening in men older than 40 in category 2B (non-uniform National Comprehensive Cancer Network consensus based on lower level evidence, including clinical experience, that the recommendation is appropriate).4
We would welcome the publication of the consent form approved by the Trent
multicentre research ethics committee.
Alain Braillon doctor
braillon.alain@chu-amiens.fr
Gérard Dubois doctor, Public Health, University Hospital, Amiens 80000, France
Competing interests: None declared.
1 Lane JA, Howson J, Donovan JL, Goepel JR, Dedman DJ, Down L, et al. Detection of prostate cancer in unselected young men: prospective cohort nested within a randomised controlled trial. BMJ 2007;335:1139-43. (1 December.)
2 Gignon M, Braillon A, Chaine FX, Dubois G. Le dépistage du cancer de la prostate: hétérogénéités des recommandations. Une exception française? Can J Public Health 2007;98:212-6.
3 Dépistage du cancer: EDIFICE analyse les comportements. Écho Roche officine 2006:6. www.rochediagnostics.fr/htdocs/media/pdf/revues/echo_roche/off20/20_p6.pdf
4 National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology. 2007. www.nccn.org/professionals/physician_gls/PDF/prostate_detection.pdf
Prognostic pessimism
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