[Screening for prostate cancer: synthesis].
Screening for prostate cancer (PCa) remains a matter of debate. Although the results of two ongoing randomised trials will be available in 2008, mass screening of PCa is already effective in the United States where PCa-related mortality has very significantly decreased. However, such screening is strongly suspected to induce "over-diagnosis". This results in the treatment of insignificant PCa, but in a significant complication rate. This situation finds an explanation in the low specificity of PSA, the screening tool for aggressive PCa. ALL of the debate is based on a misunderstanding between the pros and the cons of screening. On one hand, if diagnosis is considered a search for knowledge, then advocate an "over-diagnosis" would mean advocate an "over-knowledge", which is nonsense. On the other hand, if treatment is considered a search for action on the natural history of a disease, then advocate an "over-treatment" would mean advocate an "over-action", which is meaningful. The problem induced by screening is not to search for a disease, but what we do with it when we find it! Before recommending mass screening for PCa, we have to re-educate our patients in their understanding of the disease and re-educate ourselves in our treatment decision process. Waiting for a governmental decision about PCa screening policy, one should actually consider individual screening, which allows for personal education of patients.
Mongiat-Artus
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Service d'urologie, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France. pierre.mongiat-artus@sls.aphp.fr
Teillac
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D006801:Humans; D008297:Male; D008403:Mass Screening; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000175:diagnosis*
D017430:Prostate-Specific Antigen