Prostate cancer screening: Careful risk assessment vital

The Straits Times; Published on Oct 28, 2011
Prostate cancer screening: Careful risk assessment vital
I REFER to the article on the new United States Preventive Services Task Force recommendation about PSA screening ('Prostate cancer test 'does have benefits''; Oct 20).
The task force, a non-governmental panel comprising internists, nurses and health behaviour specialists, advised that PSA (Prostate Specific Antigen) screening should not be performed for all age groups as it 'results in small or no reduction in prostate cancer-specific mortality'.

Population screening for prostate cancer using the PSA blood test is controversial because of concerns of test specificity, overdiagnosis and overtreatment in healthy asymptomatic men. Like all tests, the PSA test is not perfect. Until better cancer markers are developed, we need to analyse the result of this test rationally with other clinical parameters to guide us in their management.
Two recent large clinical trials on PSA screening with seemingly conflicting results have added to public confusion.
Analysis of these trials showed that the American trial had statistical contamination of the non-screened group with men with prior PSA screening, while the European study showed a 20 per cent relative reduction in death from prostate cancer in the PSA-screened group when the data was confined to men aged between 55 and 69. Data from both trials are still being collected.
In general, the public needs to differentiate PSA screening from PSA testing for men with urinary symptoms or high risks for prostate cancer, where the benefit is more obvious.
To declare that the test is futile in a sweeping statement would be to ignore the benefit it has conferred on countless men who had aggressive prostate cancers detected by it, and who continue to depend on it to detect cancer recurrence after treatment.
In Singapore, we do not advocate population screening of prostate cancer in asymptomatic men using the PSA test, mainly because PSA screening is not a cost-effective tool for all asymptomatic men. This is especially so in men with short life expectancy, such as those above 75 years old or those with serious medical conditions where there are competing causes of death.
We advocate careful risk assessment and patient counselling about prostate cancer detection by a well-trained physician. In those with abnormal PSA tests where further evaluation is necessary, discussion with a urologist experienced in the care of prostate cancer is recommended. In experienced hands, the risks of overdiagnosis, overtreatment and adverse events after treatment of prostate cancer can be minimised.
Dr Michael Wong Yuet Chen
President
Singapore Urological Association
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