How many early detected prostate cancers are needed to prevent one death?
OBJECTIVE
To determine the clinical significance of diagnosis and treatment of prostate cancer diagnosed in asymptomatic patients, in terms of survival and to face its disadvantages.


METHODS
We reviewed the literature in order to know the number of men that must be reviewed through analysis of PSA, biopsy and surgery to prevent the death of one of them, as well as knowing the amount of disadvantages associated with the process.


RESULTS
We summarized, in the case of men older than 50 years, that 1 in 9 have PSA greater than 4 ng/ml. We must biopsy 3 men if PSA is between 4 - 10 ng/ml to find one prostate cancer. In order to prolong the life of one patient it is necessary a total of 18.5 prostatectomies if the tumor is palpable and the number of prostatectomies needed in the case of non- palpable tumors is estimated five times higher. In return, there will be one death per 9791 males initially checked, one incontinence per 147 males and one impotence per 58 male impotence. Three papers report that tumor spread may be caused by the biopsies.


CONCLUSIONS
We highlight the limited evidence for the data in terms of survival. It warns about the difference in results between the centers of excellence and the rest, and creates doubts about the definition of cancer when it cannot be demonstrated beyond the biopsy. The usefulness of finding and treating early prostate cancers is questionable in terms of cost-benefit, recommending the transfer of this information to patients, before deciding on one or another option. We stress the need for long- term prospective investigations to clarify which cases need to be treated and to prevent overdiagnosis. We should consider whether it is worth looking further histological findings, in increasingly younger males and with lower PSA limits.
Valle Gerhold
Jorge
J
Urology Department, Hospital Clinico Universitario Zaragoza, Spain. vallegerhold@gmail.com <vallegerhold@gmail.com>
D001706:Biopsy; D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D017430:Prostate-Specific Antigen; D011471:Prostatic Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000401:mortality* / Q000628:therapy
D017430:Prostate-Specific Antigen