A Pragmatic Approach to Prostate Cancer Screening
Mené en Finlande auprès de 61 193 hommes âgés de 50 à 63 ans invités ou non à participer au dépistage du cancer de la prostate (âge moyen : 57,2 ans), cet essai randomisé évalue la performance, du point de vue du taux de détection de lésions cancéreuses, d'un dosage sérique du PSA suivi, si le niveau est supérieur ou égal à 3.0 ng/mL, de 4 dosages supplémentaires (PSA total, PSA libre, PSA intact et kalicréine 2) puis, en fonction des résultats trouvés (système de score), d'une IRM de la prostate complétée si nécessaire par des biopsies ciblées
The introduction of prostate-specific antigen (PSA)–based screening for prostate cancer in the early 1990s was followed by a nearly 2-decade long decline in prostate cancer metastasis and mortality. However, clinical trial data revealed that screening was associated with substantial harms. Under the traditional clinical approach in which elevated serum PSA triggered prostate biopsy, roughly 1 in 5 screened men underwent biopsies, with more than 75% found to be negative and a majority of positive biopsies harboring low-grade, clinically insignificant cancers. Prostate biopsies are uncomfortable for patients and carry a risk of bleeding and infection requiring hospitalization. Moreover, during a previous era in which a cancer diagnosis was inexorably linked to treatment, overdiagnosis (ie, detection of indolent cancers that would not have been detected during life in the absence of screening) and overtreatment resulted in significantly reduced quality of life. In 2012, the US Preventive Services Task Force (USPSTF) provided a grade D recommendation against the use of PSA screening, concluding that the benefits of PSA-based screening for prostate cancer do not outweigh the harms.
JAMA , éditorial en libre accès, 2023