Prostate cancer screening. Dr J P McMenamin. Prostate cancer. An important health problem in NZ. Approx 500 men die of prostate cancer every year. 13% male cancer deaths (3 rd most common after lung and bowel). Prostate cancer. 75% new diagnoses 70+ years Estimated lifetime risk of:
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Dr J P McMenamin
diagnosis = about 16%
prostate cancer death 3% to 4%
(45% over 70yrs, 30% over 80yrs)
(African American ethnicity a risk,
Maori incidence rising)
( up to x 2 for one, x 5 – 11 for more affected 1st degree relatives)
( PSA 4 – 10)
(lower cut-off younger men = more biopsies, higher cut-off older men = more cancers missed)
Most deaths (over 60%) occur in men 75 years of age and older
(a reduction in all-cause mortality, resulting in an actual increase in life expectancy, will be difficult to accomplish in this age group)
(RCT has shown reduction in disease-specific but not all-cause mortality)
PSA results in the detection of cancers at an early stage.
Treatment of early stage cancers has better disease outcomes
But the fact that a cancer can be detected earlier in its natural history is no guarantee that benefit will follow
Screening for prostate cancer can substantially impair the quality of life of those with detected and treated cancer, that would not otherwise have reduced life expectancy.
(infection 1%, bleeding 50%)
- Some degree incontinence 38%
- Sexual dysfunction 50% - 60%
“Decisions on the introduction of population-based screening for prostate cancer cannot be made before RCTs have been completed.”
The International Prostate Screening Trial