Prostate Cancer Screening
Description
More than one in six men will develop prostate cancer in their lifetime. In recent years there has been an explosion of information regarding PSA screening and biomarkers for the disease. In Prostate Cancer Screening, Second Edition, the world's leading experts on prostate cancer detection update the first edition with the latest findings. The book incorporates a series of thoughtful and cutting-edge works from the world's experts in prostate cancer screening, ranging from the current status quo of prostate cancer screening across the globe to consensus on optimal utilization of the traditional PSA and DRE tests, to cutting-edge research in new biomarkers, biomeasures, and extended risk algorithms for prostate cancer. An additional chapter covers family-based linkage analysis as well as possible pitfalls in prostate cancer biomarker evaluation studies. Timely and authoritative, Prostate Cancer Screening, Second Edition, is an essential text for urologists, oncologists and family physicians, as well as researchers in the biomarker industry who seek methods to better develop and support markers and measures of prostate cancer.
Reviews / Votes
From the reviews of the second edition:
"This compilation of 27 chapters written by well known urology experts covers a wide range of topics from trends in PSA screening to PSA isoforms . .This book is most suitable for statisticians, scientists, or clinicians who wish to draw their own conclusions regarding PSA screening and related topics. . This book is a superb resource for anyone interested in PSA screening . . It is also an excellent reference for anyone interested in comparing the various studies and controversies from different healthcare systems . ." (Jack H. Mydlo, Doody's Review Service, May, 2009)
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Content
A small scale study of screening acceptability was performed in the UK in the late 1980s, which demonstrated that men in the community will attend for PSA testing if invited (6). As PSA testing became widely available in the following years, the Department of Health discouraged the use of PSA testing for prostate cancer screening, until the late 1990s. In 1995, the Health Technology Assessment (HTA) programme commissioned two systematic reviews of the literature, which clearly stated that there was insufficient evidence to recommend mass-screening for prostate cancer as a public health policy (7,8).
The reviews recommended that urgent research into screening and treatment of prostate cancer should be undertaken in the form of large RCTs. Subsequently, HTA issued a call for primary research in this area, and commissioned the feasibility phase of the ProtecT (Prostate testing for cancer and Treatment) study, followed by the full trial in 2001 (9,10). The ProtecT study is currently the largest randomised controlled trial of treatment effectiveness in prostate cancer worldwide. The feasibility phase demonstrated that screening was acceptable amongst British men, and that the majority agreed to be randomised to a three-arm trial of active monitoring, radical prostatectomy, and 3-D conformal radiotherapy.
The main trial started in 2001, and aims to test 130,000 asymptomatic men aged 50-70 years over a period of 5 years. Of those, 1,800 patients with clinically localised prostate cancer will be randomised to active monitoring, radical prostatectomy, or radiotherapy. The primary end-point will be survival at 10 years, with a number of secondary end-points including detailed quality of life analyses.
The study has been extended through further support from Cancer Research, UK and the Department of Health to include the evaluation of case-finding. This effectively converted the ProtecT study into the intervention arm of a clustered randomised trial of screening. Recruitment to the study is near completion, and results will become available within the next decade, at the same time as the other much awaited screening studies in Europe and the USA.
By the year 2000, the UK Department of Health recommended that if a man requested PSA testing to be screened for prostate cancer, careful counselling should be givenregarding the uncertainties surrounding the diagnosis and treatment of the disease, and PSA testing should be performed only after the man is fully informed and able to make such a decision. Despite the absence of a proven benefit from PSA-based prostate cancer screening recent years have seen a modest rise in the number of men undergoing ad hoc PSAtest screening in the UK.
A study in England and Wales suggests that the annual rate of PSA testing in men aged 45-84 years without a previous prostate cancer diagnosis is approximately 6% (11), which remains low compared to rates of testing in Western Europe and in the USA where a recent estimate suggested testing rates of over 25% in men aged 50-75 years (12).
