[Etiology of prostate cancer and significance of screening for early prostate cancer].
The incidence and mortality rate of prostate cancer in Japan are lower than in Western countries. Though studies of migrating populations would suggest that dietary or environmental factors may influence the etiology of the disease. The Westernized lifestyle after the Second World War may have influenced the increasing incidence of this disease in Japan. The screening by prostate specific antigen (PSA) on an asymptomatic healthy population can detect early prostate cancer. It is expected that the mortality may be decreased through such a system. However, some scientists hesitate to perform an aggressive program of early detection because of the possibility of latent cancer detection, the difficulty of distinguishing between clinically important and unimportant cancer, a high false positive rate to detect early stage cancer, and the lack of well-executed randomized prospective studies. Current clinical studies of the prostate cancer have demonstrated that the unimportant cancer detection rate by PSA was less than 10%. When a 4.0 ng/ml PSA cut-off value is applied for early detection, the false positive rate is approximately 80%. It is important to make subjects examined by the screening program aware of its the meaning. However, there is not a complete and cost-effective diagnostic modality to detect early prostate cancer. Moreover, it is confirmed that radical prostatectomy improves survival, but it has not been confirmed to improve the mortality based on population. We propose that well-executed randomized studies by the end point of the survival, cancer death rate, cost effective, QOL and etc. are urgently needed.
Imai
K
K
Dept. of Urology, Gunma University School of Medicine, Japan.
Fukabori
Y
Y
Yamanaka
H
H
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D004032:Diet; D005189:False Positive Reactions; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008019:Life Style; D008297:Male; D008403:Mass Screening / Q000191:economics; D008875:Middle Aged; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control
D017430:Prostate-Specific Antigen