We agree that the reason for systematic screening is the severity of the disease, having an effective method of early detection, and the availability of an early treatment that has a substantial effect on mortality rates. In 2007, however, informed consent to participate in screening is essential. To obtain informed consent, all the conclusive evidence on the risks and benefits of screening must be clearly presented. We did this in our article.1
Increasingly, the use of the prostate-specific antigen test is being questioned. Several recent studies and reviews have discussed the important limitations of this marker both for detection of the disease and for making a prognosis for patients with prostate cancer.2–6
Treating localized cancer with prostatectomy has only a modest effect on mortality from prostate cancer.7 The reduction in mortality, expressed only in relative terms (reduction of 50%), is misleading and not useful for communicating the facts to patients. As described in our article,1 of 100 patients who underwent prostatectomy and were followed up after 10 years, only 5 had actually benefited from the procedure, and 95 had undergone the procedure for nothing and had risked having serious side effects!
It is too early to attribute the drop in the mortality rate due to prostate cancer in certain populations to screening. Without the results of the randomized clinical trials currently under way, the inadequacy of the data supporting systematic screening is repeatedly mentioned—with good reason.4,8,9
While we are aware that certain men could benefit from early detection of prostate cancer, we cannot dismiss the negative effect of detecting “low-risk” cancers in otherwise healthy men. Unfortunately, it is not possible to tell patients who plan to undergo prostate cancer screening whether it would be more advantageous than disadvantageous to do so. Simply making a diagnosis of prostate cancer negatively affects their quality of life.10
In light of what we know, systematic screening for prostate cancer is not justified. Our role consists of clearly communicating the benefits and risks associated with screening to our patients, taking their values and preferences into account, and ensuring that they understand the potential consequences of their choices. In this way, we help them to make decisions they are comfortable with, regardless of the outcome. This is a proven approach.11
Footnotes
Competing interests
None declared
References
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