[Status of care for prostate cancer in 2008].
Prostate cancer as the second most frequent cause of death due to malignancy in men increasingly represents a problem for health care policy that is further intensified by demographic developments."Not every prostate carcinoma identified early must be treated, but those that require therapy must be detected early!" is the current key message in individual screening programs. This means that the measures undertaken for early detection have to be discussed with the patients to inform them about their disease risk, the need for timely initiation of curative treatment, and on possible side effects. On the other hand,"overtreatment" should be avoided. Study results on the general screening benefit with level A evidence are first expected around 2010. Interim analyses with metastasis rate as the endpoint show a benefit of screening in comparison to the control group. Results of trials with level B evidence support the benefit of individual screening. The"overdiagnosis" of latent carcinomas (2-20%) as a consequence of prostate cancer screening should be dealt with by increasing the use of more precise models for active surveillance. Studies that militate against screening should be considered inadequate upon closer scrutiny since they were conducted in a patient cohort that was too old, the follow-up period was too short, and inappropriate endpoints were set.
Urologische Klinik, Kantonsspital Aarau, 5001, Aarau, Switzerland. Brigitte.Arndt@ksa.ch
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Arndt
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Kwiatkowski
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Recker
D006801:Humans; D015994:Incidence; D008297:Male; D008403:Mass Screening / Q000379:methods* / Q000706:statistics & numerical data; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D013557:Switzerland / Q000453:epidemiology; D016896:Treatment Outcome
D017430:Prostate-Specific Antigen