Population based screening for prostatic cancer : tumor features and clinical decision making

The aggregate morbidity and mortality attributed to prostate cancer are certainly sufficient to justify a search for rational, effective and efficient screening strategies. Unfortunately, the outcome of randomized controlled trials (RCTs) that investigate the efficacy of prostate cancer screening is still awaited. Before this final analysis takes place at the end of this decade, and before screening for prostate cancer can be applied as a nation-\vide health care measure, efforts should be made to optimize the validity of the screening tests, assess the quality of life in those screened, and evaluate (reduce) the costs associated with large scale screening programs. In other words, efforts should be made to make the screening regimen more effective, selective and efficient. The current thesis provides further insight into the pathology of screen-detected prostate cancer, and into its role in the clinical management of patients with this potentially lethal disease. Despite our knowledge that a definite answer on the question which cancers we wish to detect in screening programs to decrease the mortality of the disease can only be answered after the completion of RCTs, potential measures to make the screening regimen more selective and efficient are presented. Most data were obtained from the screening arm of the European randomized study of screening for prostate cancer (ERSPC), a large multicenter RCT that investigates the impact of screening on prostate cancer mortality and quality of life.

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