Prostate cancer screening as national programme: Benefits at less harm and less cost


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Harry J. de Koning1
1Erasmus Medical Center, Rotterdam

Abstract

The European Randomised Study of Screening for Prostate Cancer (ERSPC) showed that Prostate-Specific Antigen (PSA) based screening results in a 27% prostate cancer mortality reduction. Although there are especially concerns on the harms of overdiagnosis and overtreatment, it has been shown that the benefits can outweigh the harms if screening is stopped early to prevent overdiagnosis. The cost-effectiveness of a screening program limited to men aged 55-59, including active surveillance for low-risk men, is comparable to cervical cancer screening in many countries in Europe. In future, further improvements are expected in the use of active surveillance and in discrimination between indolent and significant disease due to new biomarkers and magnetic resonance imaging. However, these future developments are no reason to postpone the implementation of high quality PSA screening and reduce opportunistic PSA testing at old ages. In a next step, the ways to implement a high-quality program should be evaluated.