Sadly, cervical cancer used to be the common cause of cancer deaths in women, but fatalities greatly reduced since the development of the Pap smear in the 1930s (American Cancer...).
Would you say your chances of getting cancer is…” The responses were: very low (1,130); somewhat low (1,729); moderate (2,872); somewhat high (995); very high (353); refused (27); and don’t know (217)....
Maahum Haider, Paul H. Lange. . 2016. Breast and Prostate Cancers: A Comparison of Two Endocrinologic Malignancies. Prostate Cancer, 157-165.
Barbara K. Dunn, Ellen Richmond, Darrell E. Anderson, Peter Greenwald. . 2016. Testing the Ability of Selenium and Vitamin E to Prevent Prostate Cancer in a Large Randomized Phase III Clinical Trial. Molecular Basis of Nutrition and Aging, 567-582.
The strongest evidence of benefit for PSA screening for early diagnosis of prostate cancer is in the age group 55 to 69 years17 since this is the group studied in randomized trials. Thus, targeting of men age 55 to 69 years, after a risk benefit discussion, represents one approach to screening that is based on best evidence.
Duke Cancer Institute constellates the world-class resources of Duke University, Duke Health and the Duke Comprehensive Cancer Center into a collaborative powerhouse. We are poised to drive a paradigm shift in the way long-established cancer centers and institutes have been waging this war.
The median age at the time of prostate-cancer diagnosis was 70 years in the two study groups. Among men in whom prostate cancer had been diagnosed, the hazard ratio for death in the finasteride group was 1.01 (95% CI, 0.85 to 1.20; P=0.90); after adjustment for cancer grade, age at diagnosis, race, and a family history of prostate cancer, the hazard ratio was 0.93 (95% CI, 0.78 to 1.12; P=0.45) (). At 10 years, the rate of survival among patients with any grade of prostate cancer was 79.3% in the finasteride group and 79.5% in the placebo group. When men were classified according to cancer grade, the 10-year survival rates were 83.0% in the finasteride group and 80.9% in the placebo group among those with low-grade prostate cancer and 73.0% and 73.6%, respectively, among those with high-grade prostate cancer ().
At the time of randomization (1994 to 1997), the median age of participants was 63.2 years. As of October 31, 2011, among the men who were still alive, the median age was 78.7 years. after adjustment for age, race, and a diagnosis of prostate cancer, the hazard ratio was 1.03 (95% CI, 0.98 to 1.09; P=0.26).
When the results were limited to the subgroup of men in whom prostate cancer was diagnosed at the time of the original report, the results were unchanged. The test for interaction between treatment and cancer grade was not significant (P=0.32), indicating that the between-group difference in the risk of death from high-grade disease was not significant. The rate of prostate-cancer–specific survival could not be calculated because of the small number of men for whom the cause of death was ascertained.
Although early detection of prostate cancer by means of PSA testing may lead to reduced mortality from the disease, it also leads to a substantial overdetection of cancer, most notably the diagnosis of low-grade tumors. Despite the evidence from one randomized clinical trial showing a significant reduction in the risk of death from prostate cancer with PSA testing, the risk of overdetection contributed greatly to the recommendation of the U.S. Preventive Services Task Force against PSA testing.
Extrapolating results from one population to another must be done cautiously since the benefits of screening are dependent on the baseline incidence of and mortality from cancer without screening, the specific screening protocol, biopsy referral criteria and compliance with biopsy recommendations. The mortality from prostate cancer in the absence of screening is higher in the Netherlands and Sweden as compared to the US13 and these were the only two countries of the seven participating in the ERSPC trial where a mortality benefit was observed. Thus, the benefits of PSA-based screening seen in these two countries may not be generalizable to the US population. Further, the screening protocol, criteria for biopsy referral and compliance with biopsy recommendations differed considerably in the US population and ERSPC trial settings.
In the original PCPT, there was a relative reduction of 38% in the risk of prostate cancer with a Gleason score of 2 to 6 (). A major lingering concern, despite the evidence of enhanced cancer detection in men receiving finasteride, was the observed absolute increase in the number of high-grade cancers that were diagnosed. In 2011, the Food and Drug Administration mandated revisions to the labels for 5α-reductase inhibitors stating that the drugs may increase the risk of high-grade prostate cancer and are not approved for the prevention of prostate cancer. Specifically, there was concern that the high-grade cancers detected among men receiving finasteride would be clinically more aggressive and thus more lethal. If the increase in high-grade prostate cancers was not a finasteride-driven artifact of detection but rather reflected new high-grade cancers induced by finasteride, some increase in mortality among men receiving finasteride should become obvious during long-term follow-up.