2023-10-04 08:00:34
If there is one subject that agitates the scientific community, it is that of prostate cancer screening. Although it is commonly accepted that mass screening is not useful for this cancer, the question of the benefit of individual early diagnosis is still not resolved. The French Urology Association recommends screening from the age of 45 for patients at risk and after the age of 50 for the rest of the population. We take stock.
Organized screening for prostate cancer: an unproven benefit
Prostate cancer refers to a pathology affecting the prostate, a male sexual gland belonging to the male genital organs.. Representing 25% of male cancers, this disease remains rare before the age of 50 but its frequency increases with age. Its prognosis is very favorable, with a survival of more than 90% at 5 years.
Because prostate cancer is asymptomatic in the early stages of the disease and its progression is generally slow, only screening can diagnose this disease. But to date, the benefit of such screening in the general population has not been clearly demonstrated. Indeed, it is not certain that it will prevent deaths linked to prostate cancer. That is why French health authorities do not recommend organized screening for prostate cancer in the general populationeven for the groups of men most at risk (men with a family history, men of Afro-Caribbean origin or men experiencing occupational exposure to pesticides).
The benefit of early diagnosis for the French urology association
As for the question of the benefit of individual early diagnosis, it has still not been resolved. The French Association of Urology (AFU) encourages early diagnosis and recommends:
- Screening from age 45 for patients at risk.
- Screening between ages 50 and 70 in men with a life expectancy of more than ten years.
This screening can be carried out through two examinations:
- Rectal examination: it consists of introducing a gloved finger into the rectum and allows the doctor to check the volume, consistency and texture of the surface of the prostate. Although uncomfortable, this exam is not painful.
- The PSA (prostate specific antigen) assay: it consists of a blood test to measure the blood PSA level (a protein produced by the prostate and normally present in small quantities in the blood).
To know ! Precautions should be taken before performing a PSA test. You should in fact avoid doing it in the days following sexual intercourse, a rectal exam or physical activity such as cycling which risks increasing the PSA level.
However, it should be noted that these two examinations are not sufficiently reliable as screening tests.. A digital rectal examination may indeed be normal, but since this examination only detects palpable tumors, it does not exclude the possible presence of cancer. Furthermore, a high PSA level in the blood is not always linked to the presence of a prostate tumor and can be caused by other diseases such as benign prostatic hypertrophy, a urinary infection or acute cystitis. In this case, additional examinations should be carried out, such as an ultrasound, a scanner or even a biopsy. For the National Association of Prostate Cancer Patients (Anamacap), a moderately high blood PSA level (between 4 and 10 ng/ml) must be interpreted cautiously and it will be better to repeat the dosage in due to the frequency of individual variations.
Prostate cancer screening: a process that can be voluntary
Finally, some men may wish to be screened for prostate cancer or be offered it by their treating physician. Candidates for voluntary screening must first discuss the advantages and disadvantages of such screening with their practitioner.
Regarding the benefits, screening for prostate cancer helps reassure the patient if the medical results turn out to be normal. A low PSA level means in 90% of cases that there is no prostate cancer. If the blood PSA level is high and detected early (before any symptoms appear), the cancer may be potentially curable.
As for the disadvantages of prostate cancer screening, these may include falsely normal medical results, unnecessary medical examinations or side effects linked to the treatment implemented and affecting the patient’s daily life (urinary incontinence, impotence sexual…). The decision to engage in prostate cancer screening therefore remains a personal choice that requires serious consideration.
Déborah L., Doctor in Pharmacy
Sources
– Screening for prostate cancer. www.ameli.fr. Accessed October 2, 2023.
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