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PSA tests for prostate cancer screening

Men’s opinions on prostate cancer screening vary greatly: Some prefer not to think about it at all, while others want to take every opportunity to try to prevent prostate cancer. Either way, anyone looking into the topic of prostate cancer screening will come across conflicting information and advice, and that can make it harder to decide whether or not to be screened.The confusion starts with the various ways the examinations are talked about. Screening is sometimes referred to as prostate cancer prevention, which can give you the impression that screening can keep you from developing cancer. But none of the examinations currently offered can do that. The goal of screening is to detect prostate cancer as early as possible in the hope of increasing the chances of successful treatment.Prostate cancer is different in different men: Sometimes it grows so slowly that no treatment is needed. But it can also be aggressive, cause problems or even become life-threatening. Fortunately, most prostate cancer tumors are the slow-growing type.The only screening test for prostate cancer that has been investigated in larger studies is the PSA test. This test is designed to detect prostate cancer before it starts causing symptoms, and in turn give men better treatment options and increase their life expectancy. But PSA testing is a controversial issue. As with any screening test, the results of PSA tests are sometimes wrong, and there are some clear disadvantages too. So it is worth carefully weighing the pros and cons of the test before deciding on whether or not to have it.In Germany, PSA tests for prostate cancer screening are not covered by statutory health insurers. But many doctors offer the test as an individual health care service, which need to be paid out of pocket. The test costs about 15 to 20 euros. Because it involves a consultation and other related tests it often ends up costing around 50 euros.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: January 28, 2015

Why has prostate cancer become so common?

The aim of screening for prostate cancer is to lower the risk of dying of the disease later on. One disadvantage of prostate cancer screening is that it can detect cancerous growths that never would have caused any symptoms. Diagnoses based on screening have made prostate cancer the most common type of cancer in men.Prostate cancer is the most commonly diagnosed type of cancer in men. In Germany alone, about 67,000 men are now diagnosed every year. This diagnosis was a lot less common 30 years ago: in 1980, for example, just over 20,000 men were diagnosed with prostate cancer per year.Cancer is slowly but surely becoming more common in general. One reason for this is the increase in life expectancy. Cancer – including prostate cancer – is most common in older people. Because more and more people are living to 70, 80 or 90, the number of people who have cancer is going up too.But when it comes to prostate cancer, gains in life expectancy are not the main reason why it has become more common. This can be shown by examining changes in life expectancy using a statistical approach called age adjustment.The illustration below shows the results: the number of men out of 100,000 who have had prostate cancer and how many have died of it per year since 1980 – assuming that the average age of men has remained constant.According to these figures, the rate of diagnosis has roughly doubled. In 1980, 53 out of 100,000 men developed prostate cancer, compared to about 110 out of 100,000 in 2008. At the same time the risk of dying of the disease has dropped: from 25 to about 20 out of 100,000 men. 

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: March 1, 2013

Prostate cancer: Overview

Prostate cancer is a malignant tumor in the prostate, a gland that is part of the male internal reproductive system. The prostate is a gland about the size of a chestnut, and is located between the bladder and the pelvic floor muscles.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: March 28, 2013

Benign enlarged prostate: Overview

Many middle-aged men will know what it is like to have to go to the bathroom a lot at night and still feel like your bladder is never really empty. This problem is usually caused by a benign enlarged prostate. Here we describe the various treatment options for this condition.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: January 15, 2014

Treating Localized Prostate Cancer: A Review of the Research for Adults

This summary will tell you about What localized prostate cancer is Common treatment options for localized prostate cancer (watchful waiting, active surveillance, surgery to remove the prostate gland, radiation therapy, and hormone treatment) What researchers found about how the treatments compare Possible side effects of the treatments Things to talk about with your doctor

Comparative Effectiveness Review Summary Guides for Consumers [Internet] - Agency for Healthcare Research and Quality (US).

Version: January 21, 2016

Benign enlarged prostate: Medication and herbal products

Most men who have prostate problems either wait a while to see how their symptoms develop, or take medication. Medication is often used when the symptoms are not bad enough for surgery to be needed, but have become too bothersome to be left untreated.This might be the case if you have to go to the bathroom several times a night, or constantly feel the need to urinate during the day too because your bladder no longer empties properly. These typical symptoms of an enlarged prostate can become a real burden.Several types of medications and combinations of medications are available for the relief of problems associated with an enlarged prostate. Like with any medication, it is important to carefully consider the advantages and disadvantages of these medications, and be aware of possible interactions between different medications. The majority of men with an enlarged prostate are over the age of 50, and often on other medications too, like drugs for high blood pressure (hypertension).For instance, if a man is taking alpha blockers for the treatment of prostate problems, he should not use impotence drugs as well. This is because both of these medications have a blood-pressure-lowering effect, so his blood pressure could become too low otherwise.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: January 15, 2014

What is overdiagnosis?

Overdiagnosis is the diagnosis of a medical condition that would never have caused any symptoms or problems.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: April 20, 2017

Lycopene for the prevention of prostate cancer

Prostate cancer is a common form of cancer affecting men worldwide. Pharmaceutical interventions, such as 5‐alpha reductase inhibitors, have been identified as potentially preventing prostate cancer incidence in men. Many men modify lifestyle and consume complementary and alternative medicines to maintain better health and prevent disease. Lycopene is a supplement that has been suggested may assist in the prevention of prostate cancer due to its antioxidant effects. The objective of this systematic review was to identify the effectiveness of lycopene in the prevention of prostate cancer. This review identified 3 relevant studies, comprising 154 participants in total. Two of the studies were assessed to be of 'high' risk of bias. Meta‐analysis of two studies indicated no statistical difference in prostate specific antigen (PSA) levels between men randomised to receive lycopene and the comparison group (MD ‐0.34, 95% CI ‐2.01 to 1.32). None of the studies assessed prostate cancer mortality. No other meta‐analyses were possible since other outcomes assessed only had one study contributing data.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Radical prostatectomy (RP) versus watchful waiting (WW) for the treatment of localized prostate cancer: a review of the evidence

In this review the best available evidence comparing the effects of two treatment options for localised prostate cancer, namely radical prostatectomy (RP) which involves surgically removing the prostate gland versus a "watchful waiting" (WW) approach was examined. In this review, WW is defined as any conservative approach to the management of prostate cancer whereby a decision is made to provide no initial treatment and to monitor the patient. If the monitoring procedure provides evidence of disease progression, then palliative treatment is offered to the patient, which is intended to alleviate disease symptoms without attempting to cure the disease.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Use of capnography in emergency department patients being sedated for procedures

Medications are often used in order to reduce pain or awareness (or both) for patients having painful procedures. Sometimes, complications involving a patient's heart, lungs, or airway (breathing tubes) can occur due to these medicines (e.g. vomit inhaled by the lungs). Healthcare workers monitor heart rate, blood pressure, breathing rate, and blood oxygen content to help prevent complications.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2017

Five‐alpha‐reductase inhibitor drugs, such as finasteride or dutasteride, reduce the risk prostate cancer in men who have routine prostate cancer screening

Five‐alpha‐reductase inhibitor drugs have potential as chemopreventive agents. Reduction of prostate cancer was similar between racial groups, age groups (aged 65 years or older compared to younger age groups) and those with or without a family history of prostate cancer. Reduction of prostate cancer was limited to men who had a baseline prostate specific antigen (PSA) values less than 4.0 ng/mL. However, use of five‐alpha‐reductase inhibitors may also increase the risk of high‐grade prostate cancer in men undergoing prostate cancer screening. Future research is needed to determine if the use of five‐alpha‐reductase inhibitors can reduce prostate cancer in men who are not being regularly screened for prostate cancer. Future studies should also determine whether five‐alpha‐reductase inhibitors can reduce death and prostate cancer death and further evaluate the risk of developing high‐grade prostate cancer.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Combining two or more drugs vs one drug for pain control in inflammatory arthritis

This summary of a Cochrane review presents what we know from research about the effect of a combination of two pain relieving drugs for pain control in inflammatory arthritis (IA).

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Prostate Cancer Screening (PDQ®): Patient Version

Expert-reviewed information summary about tests used to detect or screen for prostate cancer.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: February 17, 2017

Starting androgen suppression (hormone) therapy early, before advanced prostate cancer starts progressing may improve chances of longer survival.

The prostate gland is part of the male sex gland and is a common site of cancer in older men. Treatments for prostate cancer include surgery and radiation therapy. Male hormones (androgens) stimulate prostate cancer growth. Hormone suppression therapy, decreasing the levels of these hormones, is therefore also used to try to treat prostate cancer. It is not clear however whether it is better to start hormone treatment straight after diagnosis, or to wait until the disease progresses. The review found that early hormone suppression treatment decreased the progression of advanced prostate cancer and improved survival. Further studies are needed.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Prostate Cancer Treatment (PDQ®): Patient Version

Expert-reviewed information summary about the treatment of prostate cancer.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: July 7, 2016

Cryotherapy for localised prostate cancer

Cryotherapy is a relatively new procedure for the treatment of localised prostate cancer. Under anaesthesia, probes are inserted into the prostate tumour that freeze the tissue, thereby killing tumour cells. This procedure is carried out on a day‐patient basis and generally patients are allowed home the following day. The main complications associated with cryotherapy include impotence (inability to maintain an erection), incontinence, and tissue sloughing (making urination difficult). Studies report that cryotherapy has potential clinical benefits for many patients with no evidence of cancer postoperatively; however, the quality of the available evidence is poor.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Prostate Cancer, Nutrition, and Dietary Supplements (PDQ®): Patient Version

Expert-reviewed information summary about the use of nutrition and dietary supplements for reducing the risk of developing prostate cancer or for treating prostate cancer.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: June 9, 2017

Screening for prostate cancer

Prostate cancer is one of the most prevalent forms of cancer in men worldwide. Screening for prostate cancer implies that diagnostic tests be performed in the absence of any symptoms or indications of disease. These tests include the digital rectal examination (DRE), the prostate‐specific antigen (PSA) blood test and transrectal ultrasound (TRUS) guided biopsy. Screening aims to identify cancers at an early and treatable stage, therefore increasing the chances of successful treatment while also improving a patient's future quality of life. This review identified five relevant studies, comprised of 341,342 participants in total. Two of the studies were assessed to be of low risk of bias, whilst the remaining three had more substantive methodological weaknesses. Meta‐analysis of all five included studies demonstrated no statistically significant reduction in prostate cancer‐specific mortality (risk ratio (RR) 1.00, 95% confidence interval (CI) 0.86 to 1.17). Meta‐analysis of the two low risk of bias studies indicated no significant reduction in prostate cancer‐specific mortality (RR 0.96, 95% CI 0.70 to 1.30). Only one study included in this review (ERSPC) reported a significant 21% relative reduction (95% CI 31% to 8%) in prostate cancer‐specific mortality in a pre‐specified subgroup of men. These results were primarily driven by two countries within the ERSPC study that had very high prostate cancer mortality rates and unusually large reduction estimates. Among men aged 55 to 69 years in the ERSPC study, the study authors reported that 1055 men would need to be screened to prevent one additional death from prostate cancer during a median follow‐up duration of 11 years. Harms included overdiagnosis and harms associated with overtreatment, including false‐positive results for the PSA test, infection, bleeding, and pain associated with subsequent biopsy.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Radiotherapy after surgery for prostate cancer

Surgical removal of the prostate has a high chance of cure when prostate cancer is confined to the prostate. High‐risk features (ie, cancer that has spread through the capsule surrounding the prostate into the nearby seminal vesicles or to the edge of the surgical specimen) found at the time of surgery increase the risk of the cancer recurring. Recurrence of cancer might show up as an abnormal blood test (increased prostate‐specific antigen (PSA)), local recurrence at the site of the prostate, or distant spread (most commonly to bones).

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Chemotherapy for men with prostate cancer who have not responded to hormone therapy

Men with advanced prostate cancer and painful bone metastases are a difficult group of patients to treat. Data from recent randomised trials of chemotherapy suggest an improvement in overall survival, pain relief, and quality of life with this form of therapy. Side effects are common and can be severe. Chemotherapy offers a treatment option for men with hormone‐refractory prostate cancer (HRPC), but the decision to treat should be carefully considered by the patient and clinician. More studies are needed to find new and better agents.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

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