A discussion on controversies and ethical dilemmas in prostate cancer screening
Bibliographic Data
| ID | 21515101 |
|---|---|
| Authors | Satish Chandra Mishra (0000-0001-6086-6541, Bhabha Atomic Research Centre, corresponding author) |
| Year | 2021 |
| Volume | 47 |
| Issue | 3 |
| Pages | 152-158 |
| Publication date | 2021-03-01 |
| Open Access | No |
| Type | ARTICLE |
| Venue | Journal of Medical Ethics (JOURNAL) |
| Journal identifiers | ISSN: 0306-6800 • E-ISSN: 1473-4257 |
| Publisher | BMJ (PUBLISHER • GB) |
| DOI | 10.1136/medethics-2019-105979 |
| PMID | 32631969 |
| OpenAlex | W3039661384 |
| Language | EN |
| References cited | 107 |
Prostate cancer (PCa) is one of the the most common cancers in men. A blood test called prostate-specific antigen (PSA) has a potential to pick up this cancer very early and is used for screening of this disease. However, screening for prostate cancer is a matter of debate. Level 1 evidence from randomised controlled trials suggests a reduction in cancer-specific mortality from PCa screening. However, there could be an associated impact on quality of life due to a high proportion of overdiagnosis and overtreatment as part of the screening. The US Preventive Services Task Force (USPSTF) in 2012 recommended that PSA-based PCa screening should not to be offered at any age. However, considering the current evidence, USPSTF recently revised its recommendation to offer the PSA test to men aged 55–69 years with shared decision-making, in line with earlier guidelines from the American Cancer Society and the American Urological Association. A shared decision making is necessary since the PSA test could potentially harm an individual. However, the literature suggests that clinicians often neglect a discussion on this issue before ordering the test. This narrative discusses the main controversies regarding PCa screening including the PSA threshold for biopsy, the concept of overdiagnosis and overtreatment, the practical difficulties of active surveillance, the current level 1 evidence on the mortality benefit of screening, and the associated pitfalls. It offers a detailed discussion on the ethics involved in the PSA test and highlights the barriers to shared decision-making and possible solutions
Cancer · Cancer screening · Family medicine · Gynecology · Harm · Intensive care medicine · Overdiagnosis · Prostate cancer · Prostate cancer screening · Prostate-specific antigen · Genital Health and Disease · Medicine · Prostate Cancer Diagnosis and Treatment · Prostate Cancer Treatment and Research · Psychology · Social Psychology · Internal Medicine
| Highly cited | No |
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