Article

Screening for prostate cancer

Department of Epidemiology&PreventiveMedicine, School of PublicHealth&PreventiveMedicine,MonashUniversity,Melbourne,Australia. .
Cochrane database of systematic reviews (Online) (Impact Factor: 5.94). 01/2013; 1(1):CD004720. DOI: 10.1002/14651858.CD004720.pub3
Source: PubMed

ABSTRACT Any form of screening aims to reduce disease-specific and overall mortality, and to improve a person's future quality of life. Screening for prostate cancer has generated considerable debate within the medical and broader community, as demonstrated by the varying recommendations made by medical organizations and governed by national policies. To better inform individual patient decision-making and health policy decisions, we need to consider the entire body of data from randomised controlled trials (RCTs) on prostate cancer screening summarised in a systematic review. In 2006, our Cochrane review identified insufficient evidence to either support or refute the use of routine mass, selective, or opportunistic screening for prostate cancer. An update of the review in 2010 included three additional trials. Meta-analysis of the five studies included in the 2010 review concluded that screening did not significantly reduce prostate cancer-specific mortality. In the past two years, several updates to studies included in the 2010 review have been published thereby providing the rationale for this update of the 2010 systematic review. To determine whether screening for prostate cancer reduces prostate cancer-specific mortality or all-cause mortality and to assess its impact on quality of life and adverse events.

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    • "For example, a panel of moderate-risk genetic variants (with average OR of 3) that are present in 20% of the population would enable targeted PSA screening of 20% of the population and would detect 60% of all prostate cancers in the population. Currently, PSA screening has not been shown to decrease overall mortality from prostate cancer in the general population, but it might perform better in the high-risk setting (Ilic et al., 2013). To date, we have identified six other founder alleles in three genes (CHEK2, HOXB13, and NBN) that predispose to prostate cancer in Poland, and in combination with rs188140481, these have a combined prevalence of 7.0% in the population (Cybulski et al., 2013b). "
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    ABSTRACT: A number of single nucleotide polymorphisms (SNPs) in the human genome have been associated with increased risk of prostate cancer. Recently, a single SNP in the region of chromosome 8q24 (rs188140481) has been associated with a three-fold increased risk of prostate cancer in Europe and North America. To establish whether rs188140481 is associated with the risk of prostate cancer in Poland, we genotyped 3467 men with prostate cancer and 1958 controls. The A allele of rs188140481 was detected in 44 of 3467 (1.3%) men with prostate cancer and in seven of 1958 (0.4%) controls (odds ratio=3.6; 95% confidence interval 1.6-7.9; P=0.0006). The allele was present in eight of 390 (2.1%) men with familial prostate cancer (odds ratio=5.8; 95% confidence interval 2.1-16.2; P=0.001). A positive family history of cancers at sites other than the prostate was observed in 27% of men who carried the rs188140481 risk allele and in 44% of noncarriers (P=0.04). No cancer at a site other than the prostate was more common in first-degree or second-degree relatives of carriers of the rs188140481 risk allele than relatives of noncarriers. The rs188140481 polymorphism in the 8q24 region confers a moderate increase in the risk of prostate cancer in Polish men. The SNP does not appear to be associated with susceptibility to cancers of other types.
    European journal of cancer prevention: the official journal of the European Cancer Prevention Organisation (ECP) 09/2014; 24(2). DOI:10.1097/CEJ.0000000000000079 · 2.76 Impact Factor
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    • "tate cancer had poorer characteristics than similar Americans . In particular , Korean prostate cancer patients between 50 and 60 years old had higher Gleason scores and higher T stages than Americans . The PSA test for the diagnosis of prostate cancer has been used in Korean for 20 years . Although its value as a screening test is controversial ( Ilic et al . , 2013 ) , the PSA test is widely used in many countries , including Korea and the US . Since the PSA testing era began , the incidence of prostate cancer in Asian populations , including Korea , has been found to be lower than that in Western countries ( Center et al . , 2012 ) . However , the average annual percentage change ( AAPC ) in Asia"
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    ABSTRACT: Background: Although the PSA test has been used in Korea for over 20 years, the incidence of prostate cancer has risen, and the associated mortality has increased about 13-fold over the 20-year period. Also, several investigators have suggested that Asians in America are more likely to present with more advanced prostate cancer than Caucasians. We compared the characteristics of native Koreans and Americans (Caucasians and African- Americans) undergoing radical prostatectomies in Korea and the US. Materials and Methods: Study subjects comprised patients at Korean and US hospitals from 2004 to 2012 who had undergone radical prostatectomies. We compared the characteristics of the subjects, including age, preoperative prostate-specific antigen (PSA) levels, body mass index (BMI), Gleason score, and pathological T stage. Results: In total, 1,159 males (502 Koreans, 657 Americans) were included. The Korean and American patients had mean ages of 67.1±6.6 and 59.2±6.7 years, respectively. The mean preoperative PSAs were 15.4±17.9 and 6.2±4.6 ng/mL (p=0.0001) and the mean BMIs were 23.6±2.6 and 28.7±4.4 kg/m2 (p=0.0001), respectively. Pathological localized prostate cancer represented 71.7% of cases for Koreans and 77.6% for Americans (p=0.07). According to age, Koreans had higher T stages than Americans in their 50s (p=0.021) and higher Gleason scores than Americans in all age groups. According to PSA, Koreans had higher Gleason scores than Americans for PSA >10 ng/mL (p<0.05). According to prostate size and Gleason scores, Koreans had higher PSA values than Americans (p<0.01). Conclusions: These results show that Korean patients have elevated risk of malignant prostate cancers, as indicated by the significantly higher Gleason scores and PSAs, suggesting a need for novel prostate cancer treatment strategies in Korea.
    Asian Pacific journal of cancer prevention: APJCP 11/2013; 14(11):6913-7. DOI:10.7314/APJCP.2013.14.11.6913 · 2.51 Impact Factor
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    • "Currently, five prospective randomised trials on PCa screening are available, and these include a total of 341 342 participants aged 45–80 yr [6]. All trials involved testing of serum concentrations of PSA, digital rectal examination (DRE) at different intervals, and thresholds for further evaluation. "
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    ABSTRACT: The recommendations and the updated EAU guidelines consider early detection of PCa with the purpose of reducing PCa-related mortality and the development of advanced or metastatic disease. This paper presents the recommendations of the European Association of Urology (EAU) for early detection of prostate cancer (PCa) in men without evidence of PCa-related symptoms. The working panel conducted a systematic literature review and meta-analysis of prospective and retrospective clinical studies on baseline prostate-specific antigen (PSA) and early detection of PCa and on PCa screening published between 1990 and 2013 using Cochrane Reviews, Embase, and Medline search strategies. The level of evidence and grade of recommendation were analysed according to the principles of evidence-based medicine. The current strategy of the EAU recommends that (1) early detection of PCa reduces PCa-related mortality; (2) early detection of PCa reduces the risk of being diagnosed and developing advanced and metastatic PCa; (3) a baseline serum PSA level should be obtained at 40-45 yr of age; (4) intervals for early detection of PCa should be adapted to the baseline PSA serum concentration; (5) early detection should be offered to men with a life expectancy ≥10 yr; and (6) in the future, multivariable clinical risk-prediction tools need to be integrated into the decision-making process. A baseline serum PSA should be offered to all men 40-45 yr of age to initiate a risk-adapted follow-up approach with the purpose of reducing PCa mortality and the incidence of advanced and metastatic PCa. In the future, the development and application of multivariable risk-prediction tools will be necessary to prevent over diagnosis and over treatment.
    European Urology 07/2013; 64(3). DOI:10.1016/j.eururo.2013.06.051 · 12.48 Impact Factor