June 29, 2009
Prostate Screening Studies
Literature review of relationship between testosterone and risk of prostate cancer also included
The July issue of European Urology, the official journal of the European Association of Urology, features an editorial by Lars Holmberg comparing the results from the European Randomised Study of Screening for Prostate Cancer (ERSPC) with the results from the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial (PLCO) In the editorial, Professor Holmberg writes that "The studies illustrate that the price to pay for 20% reduction in prostate cancer deaths is high; overdiagnosis and overtreatment are great problems. The answers lie in improving the PSA test or finding biomarkers that effectively separate aggressive cancers from slow-growing ones. We identify some priorities in the discussion about PSA testing."
Another article of interest in this issue is "Testosterone and Prostate Cancer: Revisiting Old Paradigms" by H. Isbarn et al. The notion that pathologic prostate growth, benign or malignant, can be stimulated by androgens is a commonly held belief"”but one without scientific basis. In the article, Dr. Isbarn writes that, "We therefore conducted a Medline search to identify articles addressing the relationship between testosterone and the risk of prostate cancer development. Although large prospective studies addressing the long-term effect of testosterone treatment are needed to either refute or corroborate the hypothesis, the available literature strongly suggests that testosterone treatment neither increases the risk of prostate cancer diagnosis in normal men nor causes cancer recurrence in men who were successfully treated for prostate cancer."
Next month, European Urology will publish the EAU position statement on screening for prostate cancer which takes into consideration the recent scientific information on randomised screening studies on prostate cancer (Schröder et al, NEJM 2009). The EAU adopts the conclusions of the ERSPC study and recognises the benefit of screening in terms of mortality reduction, as well as the adverse effects of overdiagnosis and overtreatment of prostate cancers which could be quantified for the first time in the setting of a randomised screening study.
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