[Diagnosis of cancer of the prostate (I): Advancements in knowledge and practice since the consensus conference of 1989. The "Cancer of the Prostate" subcommittee of the Committee of Oncology of the French Association of Urology].
The prostatic cancer screening policy in France is defined by recommendations established at the 1989 consensus conference. Mass or individual screening by serum specific prostatic antigen (PSA) assay is not recommended. The Oncology Committee of the Association Française d'Urologie has up-dated the knowledge concerning prostatic cancer screening since 1989. The results are published in the form of a series of articles referring to the criteria used as prerequisites for cancer screening programmes. This article describes: 1) Current screening and treatment recommendations in France and in other countries. 2) The progress in our understanding of the prognosis, diagnosis and treatment of prostatic cancer, justifying revision of the screening policy. 3) The methodology and results of prospective screening studies and the projections of these results on the basis of the French population. Despite the 1989 recommendations, individual screening by serum PSA assay is widely performed both due to the characteristics of the test (simple blood test, low cost, high positive predictive value) and information of the public by the media concerning the morbidity and mortality related to prostatic cancer. The current data of the literature are unable to define the impact of PSA screening on the morbidity and mortality of prostatic cancer. Randomized prospective studies are currently underway. The absence of proof of a favourable impact of PSA screening is only one of the causes of the controversy concerning this screening technique, as another source of controversy is the magnitude of iatrogenic disorders induced by screening. In patients with raised PSA, the diagnostic examinations (biopsy) and curative treatments (surgery or radiotherapy) proposed are invasive, responsible for considerable morbidity and non-negligible mortality. Finally, the cost of screening remains unknown. Future recommendations must adapt their conclusions to changes in the current situation, in which prostatic cancer is simultaneously considered to be a non-serious disease which does not justify screening and a serious disease, as soon as the diagnosis is made, justifying, for 95% of urologists, an invasive and mutilating treatment in men with a life expectancy of more than 10 years.
Villers
A
A
Clinique Esquirol, Agen, France.
Grosclaude
P
P
Haillot
O
O
Abbou
C C
CC
Richard
F
F
Boccon-Gibod
L
L
D001294:Attitude to Health; D014408:Biomarkers, Tumor / Q000097:blood; D001706:Biopsy; D003245:Consensus Statements as Topic; D003365:Costs and Cost Analysis; D005060:Europe; D005602:France; D006266:Health Education; D006291:Health Policy; D006801:Humans; D007049:Iatrogenic Disease; D008017:Life Expectancy; D008297:Male; D008402:Mass Media; D008403:Mass Screening / Q000009:adverse effects / Q000191:economics; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy / Q000009:adverse effects; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000517:prevention & control* / Q000532:radiotherapy / Q000601:surgery; D011634:Public Health; D016032:Randomized Controlled Trials as Topic
D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen