Álvaro Páez Borda
Head of Urology Service, Hospital Universitario de Fuenlabrada, Madrid; Associate Professor of Health Sciences, Universidad Rey Juan Carlos; and Chairman of the Spanish branch of the European Randomized Study of Screening for Prostate Cancer
As the authors of this interesting opinion piece point out, screening for prostate cancer based on PSA testing remains an extremely controversial issue, as it is still unclear whether its benefits (in terms of reduced prostate cancer mortality) outweigh the risks of overdiagnosis and overtreatment. Moreover, the most widespread formulation of policy recommendations - the famous 'shared decision making' - leads to greater use of PSA among those with more access to information, creating an unacceptable inequity in a modern society.
The authors of this study - who include unquestioned authorities on prostate cancer screening - suggest that countries with the financial capacity to organise such campaigns should design their programmes to avoid overdiagnosis and overtreatment: either recommend against screening or restrict access to PSA testing outright.
As an alternative to indiscriminate screening, the authors suggest that PSA testing should be restricted to men between the ages of 50 and 70, and offering prostate biopsy to those presumed to have a high-risk cancer after a confirmatory test such as prostate MRI. Such a strategy should be monitored to ensure compliance with diagnostic protocols, rather than passively assuming adherence to procedures. Such an approach, elevated to a national programme level, would retain most of the beneficial effect of screening, and limit the number of tests.
In short, [the Council of] the European Union's 2022 recommendation in favour of prostate cancer screening programmes [PDF] finds its counterpoint in this concise, sensible and committed article.