The benefits of prostate cancer screening are most evident in men with a family history of prostate cancer, according to a study that simulated the benefits and harms of screening under various circumstances.
Interestingly, while screening reduced the risk of dying from prostate cancer, it had a negative impact on men without a known cancer risk, said the study, which appeared in the journal BMC Public Health.
“Currently, there is no reliable method to distinguish clinically relevant from clinically irrelevant tumors,” Dr. Uwe Siebert, a professor at Austria’s Tyrolean Health and Life Sciences University (UMIT), said in a press release.
“In consequence, also clinically irrelevant tumors may be treated, which unnecessarily exposes the affected patients to the unfortunately not uncommon long-term treatment complications such as erectile dysfunction, incontinence and bowel dysfunction,” added Siebert, who is also president-elect of the Society for Medical Decision Making.
The study, “Benefits and harms of prostate cancer screening – predictions of the ONCOTYROL prostate cancer outcome and policy model,” attempted to tackle the issue of overdiagnosis and overtreatment — the main risk of prostate cancer screening.
To assess its impact of quality of life, researchers analyzed what is known as quality-adjusted life expectancy (QALE). The simulation showed that for men without a familial risk, screening reduced QALE, particularly if performed on an annual basis.
Men at increased risk, depending on their age, gained QALE. But how these men viewed the risk of long-term treatment side effects affected how beneficial screening was in this group, said Dr. Nikolai Mühlberger, an assistant professor at UMIT who coordinated the study.
While active surveillance reduced overtreatment, the study showed, gains in life expectancy were offset by delayed treatment and additional tissue sampling, illustrating the delicate balance of screening.
“The study highlights the problem of overdiagnosis and illustrates the dependency of screening benefits on individual risk factors and preferences,” said Dr. Wolfgang Horninger, dean of the urology department at Austria’s Medical University of Innsbruck, which collaborated with UMIT. “Thus, it contributes to the improvement of patient counseling and supports an individual use of screening examinations, which all of us consider important issues.”
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