Mass population or individual screening of prostate cancer

The two major studies that have analyzed the impact of screening for cancer of the prostate on the specific mortality have produced contradictory results. The American randomized study PLCO (Prostate, Lung, Colorectal and Ovarian Cancer Screening) on 76 693 men aged between 55 and 74, compared a group subjected to screening (annual PSA measurement for 6 years and annual rectal examination for 4 years) and a control group. After 7 years of follow-up, there was no significant difference observed between the two groups in terms of specific mortality. The European randomized study concerned 182 160 men aged between 55 and 74, and compared a screened group (measurement of PSA on average every 4 years) and a control group. The results showed that for the men from 55 to 69 years old, there was a significant reduction (20%) in the specific death rate in the screened group. The conflicting results from these two studies maintain the controversy concerning generalized screening for prostate cancer. While the concept of "mass population screening" is still being evaluated, the early detection of prostate cancer can be proposed to individuals on the basis of objective information, so as not to underestimate it and let it evolve towards a possible aggressive cancer of the prostate. The early detection prostate cancer consists of a rectal examination and a total PSA measurement with the frequency yet to be specified. According to the ERSPC, the benefit in terms of specific survival is demonstrated in men aged from 55 to 69, with a PSA test every 4 years, although there is also a risk of over treatment. Screening could be recommended from the age of 45 for individuals having a high risk of prostate cancer: Afro-West Indian origin or a family history (at least two collateral cases or onset before age 55). The screening is not recommended for men whose life expectancy is considered to be less than 10 years because of advanced age or severe co-morbidities. The issue has been referred to the major health authorities, the INCA and the AFU, for them to elaborate recommendations within the framework of the cancer plan 2009-2013. Earlier use of the PSA test could modify the frequency of the detection test. Indeed, the initial value of the total PSA, measured before the age of 50, is predictive of the later risk of developing a prostate cancer. For an initial PSA <= 0.5 ng/ml, this risk is lower than 7.5% during the following 25 years. This risk is multiplied by 2.5 when the initial PSA level is between 0.5 and 1 ng/ml, and by 19 for an initial PSA value between 2 and 3 ng/ml. On the other hand, a recent study showed that with an initial PSA lower than 1.5 ng/ml (measured before the age of 50), the risk of developing a prostate cancer during the next 9 years is not increased. For an initial PSA >= 1.5 ng/ml, the risk increases during the first years of follow-up. It is therefore possible, in the years to come, that we will move towards earlier and more targeted detection for prostate cancer. The frequency of the tests would be as a function of the result of the first determination of PSA, measured before the age of 50. For example, the tests could be spaced out every 5 years if the initial PSA was lower than 1.5 ng/ml. Finally, if at the age of 60, the value of the PSA is < 1 ng/ml, the estimated risk to die from a prostate cancer is < 2 %, what could lead to stop any later dosage of PSA.