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March 16, 2018

Screening for prostate cancer: is it really useful?

In the US, prostate cancer is the most common cancer in men after skin cancer, and it is the third most common cause of cancer death in men. However, most of the cases are diagnosed in ages 65 years and older, and patients often live long enough that they die of other causes. Thus, prostate cancer screening to detect early cancer is questionable, as mortality and quality of life needs to be balanced against overdetection and overtreatment.

By GlobalData Healthcare

In the US, prostate cancer is the most common cancer in men after skin cancer, and it is the third most common cause of cancer death in men. However, most of the cases are diagnosed in ages 65 years and older, and patients often live long enough that they die of other causes. Thus, prostate cancer screening to detect early cancer is questionable, as mortality and quality of life needs to be balanced against overdetection and overtreatment.

The use of prostate-specific antigen (PSA) blood testing for prostate cancer screening has been widely debated. Prostate cancer survival is usually long and early detection may not reduce the probability of dying from prostate cancer.

According to the study published this month in The Journal of the American Medical Association, a randomised controlled trial in the UK that compared a single PSA screening intervention versus standard practice without screening found no significant difference in prostate cancer mortality after a median follow-up of 10 years. The PSA screening, however, resulted in the increased detection of low-risk prostate cancer cases.

There has been a significant decline in prostate cancer incidence in recent years as the changes have been made to screening protocols, even if actual cases of prostate cancer have increased. GlobalData epidemiologists forecast an increase in diagnosed incident cases of prostate cancer in the seven major markets (7MM: US, France, Germany, Italy, Spain, UK, and Japan) from 470,099 cases in 2016 to 548,394 in 2026, with an Annual Growth Rate (AGR) of 1.67%.

The US will have the highest number of cases in 2026, with 185,989, at an AGR of 2.11%, followed by Japan (116,539 cases, AGR 1.16%). No countries are expected to see a decrease in cases. GlobalData epidemiologists have attributed the increase in incident cases to male populations that are both growing and ageing, as incidence is highest in men ages 65 years and older.

The new study in the UK further supports the expectation of GlobalData epidemiologists that incidence of prostate cancer will decrease with changes to screening protocols, and the increase in cases should be attributed to the growing and ageing population.

Prostate cancer screening has been controversial, and diagnosing prostate cancer in men who have not been affected by it, leading to unnecessary anxiety and treatment, is difficult to justify. There is a need to develop and implement better strategies in diagnosing aggressive prostate cancers that need to be treated early.

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