programas cribado cancer

Nota bibliográfica cribado c próstata 2014-05

Etzioni RD, Thompson IM. What do the screening trials really tell us and where do we go from here? Urol Clin North Am. 2014;41(2):223–8. Available from: doi: 10.1016/j.ucl.2014.01.002. PMID: 24725484.

Publication of apparently conflicting results from 2 large trials of prostate cancer screening has intensified the debate about prostate-specific antigen (PSA) testing and has led to a recommendation against screening from the US Preventive Services Task Force. This article reviews the trials and discusses the limitations of their empirical results in informing public health policy. In particular, the authors explain why harm-benefit trade-offs based on empirical results may not accurately reflect the trade-offs expected under long-term population screening. This information should be useful to clinicians in understanding the implications of these studies regarding the value of PSA screening.

Roobol MJ. International perspectives on screening. Urol Clin North Am. 2014;41(2):237–47. Available from: doi: 10.1016/j.ucl.2014.01.009. PMID: 24725486.

The estimated population of the world in 2008 was 6.75 billion people, increasing by around 79 million people each year. The world population is aging. In 1970, the world median age was 22 years; it is projected to reach 38 years by 2050. The number of people in the world aged 60 years and older is expected to almost triple to 2 billion by 2050. Because cancer, especially prostate cancer, is predominantly a disease of the elderly, increases in the number of older people will lead to more cases of cancer, even if current incidence rates remain the same.

Kaffenberger SD, Penson DF. The politics of prostate cancer screening. Urol Clin North Am. 2014;41(2):249–55. Available from: doi: 10.1016/j.ucl.2014.01.004. PMID: 24725487.

The controversial recent recommendation by the United States Preventive Services Task Force (USPSTF) against prostate-specific antigen (PSA) screening for early-stage prostate cancer has caused much debate. Whereas USPSTF recommendations against routine screening mammography in younger women resulted in fierce public outcry and eventual alteration in the language of the recommendation, the same public and political response has not been seen with PSA screening for prostate cancer. It is of paramount importance to ensure improved efficiency and transparency of the USPSTF recommendation process, and resolution of concerns with the current USPSTF recommendation against PSA screening for all ages.

Knight SJ. Decision making and prostate cancer screening. Urol Clin North Am. 2014;41(2):257–66. Available from: doi: 10.1016/j.ucl.2014.01.008. PMID: 24725488.

This article presents an overview of the challenges that men encounter in making decisions about prostate cancer screening, including complex affective and cognitive factors and controversies in the interpretation of the evidence on prostate cancer screening. Shared decision making involving patient decision aids are discussed as approaches that can be used to improve the quality of prostate cancer screening decisions, including a close alignment between a man’s values, goals, and preferences and his choice about screening.

Bryant RJ, Lilja H. Emerging PSA-based tests to improve screening. Urol Clin North Am. 2014;41(2):267–76. Available from: doi: 10.1016/j.ucl.2014.01.003. PMID: 24725489.

This article updates advances in prostate cancer screening based on prostate-specific antigen, its derivatives, and human kallikrein markers. Many men are diagnosed with indolent disease not requiring treatment. Although there is evidence of a survival benefit from screening, the numbers needed to screen and treat remain high. There is risk of exposing men to the side effects of treatment for nonthreatening disease. A screening test is needed with sufficiently good performance characteristics to detect disease at an early stage so treatment may be offered with curative intent, while reducing the number of negative or unnecessary biopsies.

Taneja SS. Early detection of prostate cancer. Urol Clin North Am. 2014;41(2):xi–xii. Available from: doi: 10.1016/j.ucl.2014.03.002. PMID: 24725495.

Loeb S, Cooperberg MR. Early detection of prostate cancer. Urol Clin North Am. 2014;41(2):xiii. Available from: doi: 10.1016/j.ucl.2014.03.001. PMID: 24725496
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