Effective treatment of prostate cancer screening: A Synthesis of Findings from 27 Studies

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Original Abstract of the Article

Key Research Findings

Many studies have been conducted on prostate cancer screening and treatment, and various findings have been reported. 16 evaluated the current prostate cancer screening and treatment paradigm in light of recently published long-term results of major screening and treatment trials. Prostate cancer screening requires a careful balance between benefits, in terms of reduced prostate cancer mortality, and harms, in terms of overdiagnosis and overtreatment. 9 aimed to estimate the effect on overdiagnosis of restricting prostate-specific antigen (PSA) testing by age and baseline PSA. Also, the results of randomized studies on the early detection of prostate cancer and those of a systematic Cochrane review were compiled and interpreted, showing that there was no reduction in prostate cancer mortality or all-cause mortality but disadvantages such as unnecessary biopsies, overdiagnosis, and overtreatment. A relevant increase in overall mortality cannot be excluded. 10 New evidence from the Health Information National Trends Survey has emerged about patient-provider communication regarding prostate cancer screening and treatment. This study examined the extent of patient-provider communication for PSA testing and treatment of prostate cancer. 23 There are also papers that investigated the cost-effectiveness of PSA-based prostate cancer screening. 6 This review found that PSA-based screening is cost-effective for younger men (≤60 years old) and those with higher PSA levels (≥3 ng/ml). However, further cost-effectiveness analyses reflecting the latest clinical practices and current perspectives on the adverse outcomes of potentially unnecessary treatment are needed, especially from the US government's perspective. Prostate cancer screening and diagnosis have been guided by prostate-specific antigen levels for the past 25 years, but with the most recent US Preventive Services Task Force screening recommendations and concerns regarding overdiagnosis and overtreatment, a new wave of prostate cancer biomarkers has recently emerged. 20 These assays allow for testing urine, serum, or prostate tissue for molecular signs of prostate cancer, providing information regarding both diagnosis and prognosis. Also, a study tried to quantify the outcomes of individuals diagnosed and treated for prostate cancer in a single institution, pointing out that the current prostate cancer screening and treatment strategies may not support a holistic nationwide program. 27 14

Treatment Summary

Treatments for prostate cancer include surgery, radiation therapy, hormone therapy, chemotherapy, and more. 16 When choosing a prostate cancer treatment, it is necessary to consider the patient's age, health condition, stage of cancer, and risk factors. 9

Benefits and Risks

Benefit Summary

Prostate cancer screening may reduce prostate cancer mortality by allowing for early detection and treatment. 16 However, screening is not necessarily recommended for everyone because it carries the risk of overdiagnosis and overtreatment. 9

Risk Summary

Prostate cancer screening carries the risk of overdiagnosis and overtreatment. 9 Overdiagnosis means diagnosing cancer that would never have caused symptoms or would have only done so in the future. Overtreatment refers to unnecessary treatment for overdiagnosed cancer. Overtreatment can lead to side effects and health problems. 10

Comparison of Studies

Similarities Between Studies

Many studies have pointed out that prostate cancer screening carries the risk of overdiagnosis and overtreatment. 9 10

Differences Between Studies

Specific evaluation methods and results regarding the effectiveness and risks of screening vary among studies. 16 For instance, 6 indicated that PSA-based screening is cost-effective for younger men and those with higher PSA levels. However, other studies found no reduction in mortality from screening. 10

Consistency and Contradictions in Results

Consistent results have not been obtained from research on prostate cancer screening. 16 While some studies suggest that screening may reduce mortality, others indicate that screening carries the risk of overdiagnosis and overtreatment. 9 10 These contradictions could be explained by various factors, such as the age and risk factors of the men being screened, the screening method, and the treatment method. 9

Notes on Applying Research to Real Life

Research findings on prostate cancer screening do not necessarily apply to everyone. 16 The decision of whether to undergo screening should be made in consultation with a doctor, considering the individual man's age, risk factors, health status, and preferences for treatment. 9

Limitations of Current Research

There are still unanswered questions surrounding research on prostate cancer screening. 16 For example, research is still lacking on the long-term effects of screening and the optimal combination of screening and treatment methods. 9 Moreover, the impact of screening on mortality remains unclear. 10

Future Research Directions

Future research on prostate cancer screening needs to explore the long-term effects of screening, optimal screening methods, the combination of screening and treatment methods, and the impact of screening on mortality in more detail. 16 Also, research is needed on measures to reduce the risk of overdiagnosis and overtreatment caused by screening. 9

Conclusion

Research on prostate cancer screening is still incomplete. 16 Screening may reduce prostate cancer mortality, but it also carries the risk of overdiagnosis and overtreatment. 9 The decision of whether to undergo screening should be made in consultation with a doctor, considering the individual man's age, risk factors, health status, and preferences for treatment. 9

Treatment List

Surgery, Radiation Therapy, Hormone Therapy, Chemotherapy, Active Surveillance, Watchful Waiting

Literature analysis of 27 papers
Positive Content
19
Neutral Content
3
Negative Content
5
Article Type
7
1
8
11
27
1.

Prostate cancer screening in the prostate, lung, colorectal and ovarian cancer screening trial of the National Cancer Institute.

Author: GohaganJ K, ProrokP C, KramerB S, CornettJ E

Treatment-related morbidity
Treatment-related mortality

While the benefits of prostate cancer screening are unknown, potential treatment-related risks exist. The United States has a more enthusiastic approach to screening compared to Europe and Canada. A large, randomized, controlled trial, the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial, began in 1993 to study the effectiveness of prostate cancer screening using PSA and digital rectal exam. The study aims to determine if screening can reduce prostate cancer mortality by 20%. The study includes 74,000 men aged 60-74.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

2.

Economic evaluation of screening for prostate cancer: a randomized population based programme during a 10-year period in Sweden.

Author: HolmbergH, CarlssonP, LöfmanO, VarenhorstE

Prostate cancer screening is becoming more common, but its overall impact on survival is not clear. This study evaluated the costs and benefits of screening for prostate cancer in a Swedish community. The study found that screening would increase healthcare costs by about 179 million SEK per year, with an additional cost of 158,000 SEK for each new case of localized cancer detected. While screening could identify more localized cancers, the long-term effects on quality of life and death rates are unknown.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

3.

Prostate cancer screening: results of a prospective trial in Canton Aargau, Switzerland.

Author: KwiatkowskiM, HuberA, MoschopulosM, LehmannK, WernliM, HäfeliA, ReckerF

Prostate cancer treatment

Prostate cancer is a growing concern in Switzerland. While aggressive treatment is necessary for localized tumors, the use of screening for early-stage disease remains controversial. The ERSPC study, which the Clinic of Urology in Kantonsspital Aarau is participating in, aims to provide data on prostate cancer screening in a randomized controlled setting.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

4.

Outcome following active surveillance of men with screen-detected prostate cancer. Results from the Göteborg randomised population-based prostate cancer screening trial.

Author: GodtmanRebecka Arnsrud, HolmbergErik, KhatamiAli, StranneJohan, HugossonJonas

Reduce overtreatment
Safe for low-risk PCa

Active surveillance is a safe and effective option for men with low-risk, screen-detected prostate cancer.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

5.

Men's preferences for prostate cancer screening: a discrete choice experiment.

Author: de Bekker-GrobE W, RoseJ M, DonkersB, Essink-BotM-L, BangmaC H, SteyerbergE W

Reduced risk of death from PC
Unnecessary biopsies
Unnecessary treatment

Men were willing to trade-off some risk reduction of prostate cancer-related death to be relieved of the burden of biopsies or unnecessary treatments.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

6.

A literature review of cost-effectiveness analyses of prostate-specific antigen test in prostate cancer screening.

Author: GargVishvas, GuNing Yan, BorregoMatthew E, RaischDennis W

PSA screening cost-effective

Prostate cancer is a common cancer in men. The US Preventive Services Task Force recommends against PSA-based screening, while other organizations continue to recommend it. This study reviewed the cost-effectiveness of PSA-based screening, finding that it is cost-effective for younger men and those with higher PSA levels.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

7.

Systematic review of complications of prostate biopsy.

Author: LoebStacy, VellekoopAnnelies, AhmedHashim U, CattoJames, EmbertonMark, NamRobert, RosarioDerek J, ScattoniVincenzo, LotanYair

Cancer detection
Bleeding
Erectile dysfunction
Infection
Pain
Urinary symptoms

Prostate biopsy is commonly associated with minor bleeding, urinary symptoms, and rare infections. Infectious complications are the most common reason for hospitalization and require prompt management. Antimicrobial prophylaxis and pain management are recommended.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

8.

American Urological Association (AUA) guideline on prostate cancer detection: process and rationale.

Author: CarterH Ballentine

Improved prostate cancer detection
False positive tests
Overdiagnosis
Overtreatment

The American Urological Association (AUA) recommends shared decision-making for men aged 55-69 years who are considering PSA-based screening for prostate cancer. The AUA does not recommend routine screening for other age groups.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Practice GuidelineGuidelines and recommendations for the diagnosis and treatment of specific medical conditions in medical practice.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

9.

Empirical estimates of prostate cancer overdiagnosis by age and prostate-specific antigen.

Author: VickersAndrew J, SjobergDaniel D, UlmertDavid, VertosickEmily, RoobolMonique J, ThompsonIan, HeijnsdijkEveline A M, De KoningHarry, Atoria-SwartzCoral, ScardinoPeter T, LiljaHans

Reduced prostate cancer mortality
Overdiagnosis

A study using the US Surveillance, Epidemiology and End Results database and two clinical trial cohorts found that prostate cancer overdiagnosis has a strong relationship to age and PSA level. Restricting screening in men over 60 to those with PSA above median (>1 ng/ml) and screening men over 70 only in selected circumstances would importantly reduce overdiagnosis and change the ratio of benefits to harms of PSA-screening.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, N.I.H., ExtramuralResearch funding provided by the NIH to external research institutions and researchers.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

10.

[Early detection of prostate cancer: harm verified, benefit not verifiable].

Author: DubbenH-H

Overdiagnosis
Overtreatment

A review of studies on prostate cancer screening found no evidence that it reduces deaths from prostate cancer or overall death rates. In fact, screening led to unnecessary biopsies, overdiagnosis, and overtreatment, potentially even increasing overall death rates. The review highlights the inherent challenges of screening studies, including the need for a very large number of participants and the long time it takes to conduct such studies, which makes the results outdated by the time they are available. Based on these findings, the authors recommend against population-based prostate cancer screening.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : German

11.

[Management of low-risk prostate cancer].

Author: RozetF, BastideC, BeuzebocP, CormierL, FromontG, HennequinC, Mongiat-ArtusP, PeyromaureM, Renard-PennaR, RichaudP, SalomonL, SouliéM,

Reduced overtreatment

The widespread use of prostate cancer screening has led to a stage migration, resulting in an increase in the diagnosis of low-risk disease. New therapeutic strategies are evolving to minimize overtreatment without compromising oncological success.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : French

12.

Cost-effectiveness of prostate cancer screening: a systematic review of decision-analytical models.

Author: SangheraSabina, CoastJoanna, MartinRichard M, DonovanJenny L, MohiuddinSyed

Prostate cancer screening
Over-detection
Over-treatment

This abstract highlights the ongoing debate surrounding the harms and benefits of a national prostate cancer screening program, emphasizing the need for accurate cost-effectiveness analyses.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

13.

Cost-Effectiveness Analysis of Prostate Cancer Screening in the UK: A Decision Model Analysis Based on the CAP Trial.

Author: KeeneyEdna, SangheraSabina, MartinRichard M, GulatiRoman, WiklundFredrik, WalshEleanor I, DonovanJenny L, HamdyFreddie, NealDavid E, LaneJ Athene, TurnerEmma L, ThomHoward, ClementsMark S

Prostate cancer screening
Overdiagnosis and overtreatment

This study assessed the cost effectiveness of eight potential screening strategies for prostate cancer in the UK, considering the ongoing debate regarding population-wide screening.

Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.
Research Support, N.I.H., ExtramuralResearch funding provided by the NIH to external research institutions and researchers.

Language : English

17.

Prostate Cancer Screening: Shared Decision-Making for Screening and Treatment.

Author: BlackwelderRuss, ChessmanAlexander

Prostate cancer screening

This article discusses the controversies surrounding prostate cancer screening, evaluating issues in current pathologic patterns, epidemiology, and screening practices.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

19.

Shared decision-making for prostate cancer screening and treatment: a systematic review of randomised controlled trials.

Author: Martínez-GonzálezNahara Anani, PlateAndreas, SennOliver, MarkunStefan, RosemannThomas, Neuner-JehleStefan

Shared decision making

This systematic review examined the implementation of shared decision-making (SDM) in interventions for prostate cancer screening and treatment. It aimed to understand the extent to which SDM is being used in practice.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

20.

The Use of Biomarkers in Prostate Cancer Screening and Treatment.

Author: AlfordAshley V, BritoJoseph M, YadavKamlesh K, YadavShalini S, TewariAshutosh K, RenzulliJoseph

Improved diagnosis
Improved prognosis
Overdiagnosis
Overtreatment

This review discusses 12 commercially available biomarker assays for prostate cancer diagnosis and treatment. It aims to help urologists make informed decisions about ordering and interpreting these tests for individual patients.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

21.

A qualitative meta-synthesis examining the role of women in African American men's prostate cancer screening and treatment decision making.

Author: BergnerErin M, CornishEmily K, HorneKenay, GriffithDerek M

African American men face a higher risk of prostate cancer. This systematic review examines the roles of women, particularly wives, in prostate cancer screening and treatment decision-making among African American men.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, N.I.H., ExtramuralResearch funding provided by the NIH to external research institutions and researchers.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

24.

A genetic-based approach to personalized prostate cancer screening and treatment.

Author: HelfandBrian T, CatalonaWilliam J, XuJianfeng

Prostate Cancer Risk Stratification
Prostate Cancer Screening Improvement

This review discusses the potential of genetic variants in germline DNA for improved risk stratification and routine clinical practice in prostate cancer screening.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

26.

The influence of family ties on men's prostate cancer screening, biopsy, and treatment decisions.

Author: ShawEric K, ScottJohn G, FerranteJeanne M

Shared decision making

This qualitative study explored the influence of family ties on men's prostate cancer decisions across screening, diagnosis, and treatment. Three major themes were identified: spousal/family member alliance, men who opposed pressure and made decisions themselves, and men who yielded to pressure.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, U.S. Gov't, Non-P.H.S.Research funding provided by US government agencies other than the Public Health Service.

Language : English

27.

Historical prostate cancer screening and treatment outcomes from a single institution.

Author: CrossDeanna S, RitterMark, RedingDouglas J

Decreased age of diagnosis

The average age of prostate cancer diagnosis has decreased since the advent of PSA screening, with age, grade, and stage being the biggest predictors of outcome.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, N.I.H., ExtramuralResearch funding provided by the NIH to external research institutions and researchers.

Language : English

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