Prostate Cancer Screening: What We Know, Don't Know, and Believe
Cet article présente la mise à jour des recommandations d'un groupe d'experts américains (U.S. Preventive Services Task Force) en matière de dépistage du cancer de la prostate
Prostate cancer is a devastating illness. Approximately 28 000 American men will die of it this year (1). A method to prevent these deaths is sorely needed. For more than 20 years, many have believed that screening asymptomatic men of a certain age with serum prostate-specific antigen (PSA) is that method. Yet, every medical intervention has some harms associated with it and we must weigh those harms against potential benefits. Potential harms of PSA screening are well-documented (2), but questions surround the potential benefits: Does PSA-based screening lead to decreased morbidity and mortality? If beneficial, do the benefits outweigh the harms?
After a review of the evidence about both the benefits and harms of PSA screening and treatment of localized prostate cancer, the U.S. Preventive Services Task Force (USPSTF) gave PSA screening a grade of “D” (3). This is a recommendation against PSA-based screening for men of any age. The Task Force makes D recommendations when there is at least moderate certainty that the harms of doing the intervention equal or outweigh the benefit. Available scientific data suggesting that screening saves lives was inconsistent. Consequently, the USPSTF determined that, even assuming that available data shows that screening saves some lives, the number of lives saved is, “at most, very small” and the proven risk for harm outweighs any potential benefit.
In October 2011, the Task Force's release of a draft recommendation for public comment caused many clinicians and patients to express outrage (4). Undoubtedly, the final recommendation, which is unchanged after consideration of public comment, will upset many in the prostate cancer advocacy community. Lost in …
Annals of Internal Medicine , commentaire en libre accès, 2012