Prostate cancer screening is a screening process used to detect undiagnosed prostate cancer in those without signs or symptoms. When abnormal prostate tissue or cancer is found early, it may be easier to treat and heal, but it is unclear whether early detection reduces mortality.
Screening precedes further diagnosis and treatment. Digital rectal examination (DRE) is one of the screening tools in which the prostate is assessed manually through the rectal wall. The second screening tool is the measurement of prostate-specific antigen (PSA) in the blood. The evidence remains inadequate to determine whether screening with prostate-specific antigen (PSA) or digital rectal exam (DRE) reduces the mortality of prostate cancer. The 2013 Cochrane Review concluded the results of PSA screening in "there was no statistically significant difference in the specific mortality of prostate cancer..." American studies are determined to have a high bias. The European studies included in this review have a low bias and one reported a "significant reduction in the specific mortality of prostate cancer." PSA screening with DRE is not rated in this review. DRE is not assessed separately.
Guidelines generally recommend that the decision whether or not to screen is based on shared decision making. It involves people who are informed about the risks and benefits of filtering. The American Society of Clinical Oncology recommends screening not recommended to those who are expected to live less than ten years, while those with a life expectancy of more than ten years, decisions must be made by the person concerned. In general, they conclude that based on recent research, "it is uncertain whether the benefits associated with PSA testing for prostate cancer screening are of adverse value associated with subsequent unnecessary screening and treatment."
Prostate biopsy is used to diagnose prostate cancer but is not performed in asymptomatic men and is therefore not used for screening. Biopsy of prostate cancer is the gold standard in detecting prostate cancer. Infection after prostate biopsy occurs in about 1% of deaths due to biopsy occurring at 0.2%. A prostate biopsy guided by magnetic resonance imaging has improved diagnostic accuracy of the procedure.
Video Prostate cancer screening
Antigen khusus prostat
Prostate-specific antigen (PSA) is secreted by epithelial cells of the prostate gland and can be detected in blood samples. PSA is present in small amounts in male serum with healthy prostate, but it is often increased in the presence of prostate cancer or other prostate disorders. PSA is not a unique indicator of prostate cancer, but it can also detect prostatitis or benign prostatic hyperplasia.
The United States Prevention Force Prevention Force (USPSTF) 2018 overturned previous opposition to PCa examinations. The draft recommendation suggests joint decision making on screening in healthy men aged 55 to 69 years. The final recommendation for this age group states that screening should only be done to those who want it. At 70 and over this screening is still not recommended.
Screening with PSA has been associated with a number of hazards including over-diagnosis, increased prostate biopsy with associated damage, increased anxiety, and unneeded treatment.
On the other hand, up to 25% of men diagnosed at the age of 70s or even 80s die of prostate cancer, if they have high-grade prostate cancer (ie, aggressive). In contrast, some are opposed to testing PSA for too young men, because too many men have to be screened to find one cancer, and too many men will get treatment for cancer that will not develop. Low-risk prostate cancer does not necessarily require immediate treatment, but may be able to receive active supervision. The PSA test can not 'prove' the existence of prostate cancer by itself. Variable antigen levels can be caused by other causes.
Maps Prostate cancer screening
Anal Rectal check
During digital rectal examination (DRE), the health care provider shifts the gloved finger into the rectum and presses the prostate, to check its size and to see if any bumps are present.
A review of 2018 is recommended against screening of primary care for prostate cancer with DRE due to a lack of evidence of exercise effectiveness. If the digital exam shows an anomaly, PSA screening is then performed. If a high PSA level is found, a digital exam is then performed.
Follow-up tests
Biopsy
Prostate biopsy is considered a gold standard in detecting prostate cancer. Infection is a possible risk. MRI guided techniques have improved diagnostic accuracy of procedures. Biopsy can be done through the rectum or penis.
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Transrectal ultrasonography (TRUS) has the advantage of being rapidly minimally invasive and better than MRI for evaluation of superficial tumors. It also provides details about the rectal wall layers, accurate and useful for staging primary rectal cancer. While MRI better in the visualization of advanced cancer and local stenosa. For perirectal lymph node staging, both TRUS and MRI are capable. TRUS has a small field of view, but 3D TRUS can improve the diagnosis of anorectal disease.
Magnetic imaging
MRI imaging is used when screening shows malignancy. This model potentially minimizes unnecessary prostate biopsy while maximizing biopsy results. Despite concerns about the cost of MRI scans, compared to the long-term cost of PSA/TRUS-based maintenance standards, the imaging model has proven to be cost-effective. MRI imaging may be used for patients who have previous negative biopsies but their PSA is on the rise. Consensus has not been determined on the MRI target biopsy technique that is more useful.
Other imagery
68 Ga-PSMA PET/CT imaging has been in a relatively short period of time, the gold standard to relieve recurrent prostate cancer in clinical centers where imaging modalities are available. This tends to be a standard imaging modality in staging primary prostate primary high risk prostate cancer. The potential to guide therapy, and to facilitate more accurate prostate biopsy is being explored. In the therapeutic paradigm, Ga-PSMA PET/CT imaging is essential for detecting antigen-avid membrane prostate disease which can then respond to 177 Lu-PSMA or <. soup> 225 Ac-PSMA therapy. For local recurrence, 68 Ga-PSMA PET/MR or PET/CT combined with mpMR is most appropriate. PSMA PET/CT can potentially help to find cancer when combined with multiparametric MRI (mpMRI) for primary prostate treatment. MR imaging multiparametric prostate (mpMRI) is helpful in evaluating the recurrence of primary prostate cancer after treatment.
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- The four-kallicrein panel (4KScore) is another available test.
- The Prostate Health Index (PHI) is another available test.
- The prostate cancer 3 antigen (PCA3) is another available test.
- ConfirmMDx (MDxHealth) is another available test.
Guidelines
- In 2012, the US Preventive Services Force (USPSTF) recommends against prostate cancer screening using PSA. By 2018 the draft for new recommendations indicates that screening is individualized for those aged 55 to 69 years. This noted a small potential decrease in the risk of death from prostate cancer but damage due to overtreatment. In those over 70 screening based on PSA it is still advisable to fight. The American Cancer Society recommends that asymptomatic men who have at least 10 years life expectancy have an opportunity to make informed decisions with their healthcare provider about screening for prostate cancer once they receive information about potential uncertainties, risks, and benefits associated with prostate cancer screening Prostate cancer screening should not occur without informed decision-making process Men at average risk should receive this information starting at age 50 years Men in high-risk groups should receive this information before the age of 50. Men should receive this information directly from their health care provider or referred to a reliable and culturally appropriate source. "
- Guidelines and other centers specializing in treating prostate cancer recommend obtaining PSA in all men at age 45. This is based on emerging data showing that baseline PSA increases can be used to detect significant future diseases.
- The American Urological Association Patient Guide for Prostate Cancer. The American Urological Association said in early 2009 that "The decision to screen is one that men should do with their doctors, and should include known prostate cancer risk factors, such as family history of prostate cancer, age, race, and whether men have had previous negative prostate biopsy These factors are different for every man and, therefore, the benefits of screening should be considered in a wider perspective. "
- By 2018, the UK National Health Service does not offer a general PSA screening, for the same reasons given above. Individuals over the age of 50 who ask for it can usually obtain tests covered by the NHS.
- The Canadian Urology Association in 2017 suggests that screening is offered as a possibility for those who are expected to live more than 10 years with a final decision based on mutual decision making. They recommend an early age for most people at age 50 and 45 years among those at high risk. The Canadian Task Force on Preventive Health Care by 2014 is strongly recommended not to screen for people younger than 55 and over 70. They recommend weekly against screening among them 55-69.
- Some men have germ line mutations associated with the development of prostate cancer (eg, BRCA1, BRCA2, HOXB13). The screening and its frequency are determined after consultation with a geneticist.
Controversy
From population screening to early diagnosis there is a lack of understanding. Screening for prostate cancer continues to cause debate by doctors and a wider audience. Publications made by government, non-governmental and medical organizations continue the debate and publish recommendations for screening. One in six men will be diagnosed with prostate cancer during their lifetime but screening can lead to overdiagnosis and overtreatment of prostate cancer. Screening for prostate cancer is often diagnosed in an outpatient setting so it is fairly easily accessible. Although death rates from prostate cancer continue to decline, 238,590 men are diagnosed with prostate cancer by 2013, while 29,720 people die as a result. The death rate from prostate cancer has declined at a stable level since 1992. Prostate, lung and bronchial cancer, and colorectum accounts for about 50% of all newly diagnosed cancers in men. Prostate cancer itself is 28% of cases in men. Screening for prostate cancer varies by country and shows differences in the use of screening for prostate cancer as well as variations between locales. Of all cases of prostate cancer, African American men had an incidence of 62%. African American men are less likely to receive standard therapy for prostate cancer. This difference may indicate that if they receive better quality cancer treatment, their survival rate will be the same as that of whites. Prostate cancer is also very heterogeneous: many, probably most, of indolent prostate cancer and will never progress to a clinically meaningful stage if left undiagnosed and untreated during the lifetime of a man. On the other hand, the subset is potentially lethal, and screening can identify some of them in the window of opportunity for healing. Thus, the PSA screening concept is supported by several people as a tool for detecting high risk , potentially lethal prostate cancer, with the understanding that low-risk illness, if found, often does not require treatment and can receive active supervision.
Screening for prostate cancer is still controversial because of the uncertain long-term costs and benefits for patients. Horan echoed that sentiment in his book.
Private medical institutions, such as the Mayo Clinic, also acknowledged that "organizations vary in their recommendations about who should - and should not - get a PSA screening test.They conclude:" In the end, whether you should have a PSA test is something you should decide after discussing it with your doctor, consider your risk factors and weigh your personal preferences. "
A study in Europe only resulted in a slight decrease in mortality and concluded that 48 men needed to be treated to save one life. But of the 47 men treated, most will not be able to function sexually and require more frequent trips to the bathroom. Aggressive marketing of screening tests by drug companies has also led to controversies such as advocacy testing by the American Urological Association.
One commentator has observed: "[I] is wise only to use the determination of a single PSA as a baseline, with biopsy and cancer treatment provided to those with significant PSA changes over time, or for those with clinical manifestations requiring immediate treatment.... the absolute level of PSA is rarely meaningful, it is the relative change in PSA levels over time that provide insight, but is not the definitive proof of cancer conditions requiring therapy. "
History
In the early 1990s, prostate screening from PSA was performed. In a randomized European Screening Study for Prostate Cancer (ERSPC) beginning in the early 1990s, the researchers concluded that PSA-based screening did reduce the mortality rate due to prostate cancer but instead created a high risk of overdiagnosis, that is, 1410 men would need to be screened and 48 additional cases of prostate cancer need to be treated to prevent only one death from prostate cancer in 9 years.
A study published in the European Journal of Cancer (October 2009) documented that prostate cancer screening reduced prostate cancer death rates by 37 percent. By utilizing a male control group from Northern Ireland, where PSA screening is rare, the study showed a substantial reduction in prostate cancer death when compared with men whose PSA was tested as part of the ERSPC study.
A study published in the New England Journal of Medicine in 2009 found that over a period of 7 to 10 years, "screening did not reduce mortality rates in men aged 55 years and over." Former screening supporters, including some from Stanford University, have opposed regular testing. In February 2010, the American Cancer Society urged "more caution in using the test." And the American College of Preventive Medicine concluded that "there is not enough evidence to recommend a routine checkup."
A further study, NHS Comparison Arm for ProtecT (CAP) as part of Prostate testing for cancer and Treatment (Protect) GP randomized practice study with 460,000 men aged 50-69 at the center in 9 cities across the UK from 2001-2005 to ordinary treatment or prostate cancer screening with PSA (biopsy if PSA> = 3).df. The "Comparison Arm" has not yet reported in early 2018.
See also
- Active prostate cancer control
- Transurethral incision of the prostate
- Transurethral biopsy
References
Source of the article : Wikipedia
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