Prostate Cancer Screening: Evidence, Arguments, and Verdict

This essay critically analyzes the practice of prostate cancer screening, focusing on the benefits and potential harms associated with the most common method, the serum PSA test. It reviews available evidence from various studies, highlighting arguments for and against the use of PSA screening in detecting prostate cancer at an early stage. The essay discusses the sensitivity and specificity of PSA tests, the potential for over-detection, biopsies, and overtreatment, as well as the impact on patients' quality of life. It also considers the differing guidelines and recommendations from medical organizations worldwide, including the European Association of Urology and the United States Preventive Services Task Force. Furthermore, the essay examines the emergence of novel biomarkers and the need for cost-effective and less harmful screening modalities, concluding that while early detection is crucial, the current methods require improvement to ensure that the benefits outweigh the risks.

Running head: PROSTATE CANCER SCREENING
Prostate Cancer Screening
Name of the student:
Name of the university:
Author note:

1
PROSTATE CANCER SCREENING
Table of Contents
Introduction:....................................................................................................................................2
Available evidence review:..............................................................................................................2
Argument and verdict:.....................................................................................................................3
Conclusion:......................................................................................................................................4
References:......................................................................................................................................5

2
PROSTATE CANCER SCREENING
Introduction:
Screening is one of the most effective technologies used to reduce mortality associated
with cancer (Drazer, Huo and Eggener 2015). Although, there is considerable argument
questioning whether the benefits associated with cancer screening is worth the harm that it may
implement. This essay will review the available literature evidences to explore the positive and
negative side of the argument and provide personal verdict on whether the benefits associated
with prostate cancer screening outweigh the harms facilitated by it.
Available evidence review:
As discussed by Duffy (2014), the aim of prostate cancer screening is detecting the
malignancy at an early stage so that it is potentially treatable. However, the most abundantly
used technique of prostate cancer screening is serum PSA which has been any used in medical
screening for prostate cancer for over 20 years. There is mounting evidence that indicates that the
controversial arguments surrounding the practice of serum PSA screening associated with
prostate cancer as the technique lacks sensitivity and specificity for the early detection.
Although there are various research evidences that indicates that the effectiveness of this Pioneer
testing methodology. Many recent research studies have argued that serum PSA screening leads
to unnecessary over- detection, biopsies, and even over- or maltreatment, facilitating more harm
than benefit (Duffy 2014).
Elaborating further, the article by Duffy (2014) stated that the published guidelines across
the globe differ in the recommendation for serum PSA screening for prostate cancer. Also, one
common factor in all of the guidelines is that men should be informed of the risks and benefits of
the process before going forward with the testing. Along with that globally most of the

3
PROSTATE CANCER SCREENING
guidelines for serum PSA prostate cancer screening also state that when that have life expectancy
lesser than 10 years should not even be screened using this Pioneer technique.
On another note different research studies have also stated the process specific antigen or
PSA screening methods to detect early symptomatic prostate cancer as well. Also as discussed
by Mühlberger et al. (2017), the mortality reduction for the trials is still conflicting and the
potential gains is outweighed by the loss of quality of life due to the over diagnosis and over
treatment. The medical organizations in Europe and United States including the European
Association of Urology and the United State Preventative Service Task Force do not advocate
using PSA based screening for routine purposes due to the uncertain benefits and possible harms
(McCarthy 2013).
Argument and verdict:
Although there are medical research trials that have provided substantial positive results
of using PSA based prostate cancer screening in different location across the world as well. For
instance, an observational study from the Austrian state of Tyrol has provided results of 30%
screening related decline of prostate cancer mortality after free PSA screening introduced for the
age group of men belonging to the age group of 45 to 74 years in the year of 1993. Similarly
another randomized control trial study in the European continent for the screening of prostate
cancer demonstrated 29% reduction in the mortality associated with prostate cancer at follow-up
of 11 years after the screening and also reported a reduction in metastatic disease diagnosis of
30% and a 12 year follow-up study (Mühlberger et al. 2017).
Hence it can be stated that although PSA based prostate cancer screening is the only
feasible and cost-effective prostate cancer screening modality that can detect the disease at a very

4
PROSTATE CANCER SCREENING
early stage. The advantages for this includes specialized treatment designing and evading the
risk of mortality allowing the patient to live a long and comfortable life following personalized
and patient centred treatment of the prostate cancer which cannot be given if the diagnosis is
made at a later stage when the cancer is already advanced and is at uncontrollably malignant
state (Walteret al. 2017). Similarly the negative side of the argument also indicates at
considerably affected quality of life and even lower life expectancy due to over diagnosis and
over treatment (Drazer, Huo and Eggener 2015). A few novel biomarkers of prostate cancer
screening are being introduced by the research including 2proPSA, prostate health index, and
PCA3. Hence, there is need for better and less harmful prostate cancer screening modalities are
being introduced in the market in a cost effective manner so that the benefits of the screening
procedure can outweigh the harms.
Conclusion:
On a concluding note fastest cancer screening is associated with both benefits and harms.
The PSA mediated screening on the other hand has more harmful impacts than benefits that it is
providing. Hence, there is need for further research to develop more cost effective and harmless
methods of screening so that patient safety and wellbeing can be registered under all
circumstances and the harmfulness of a screening procedure does not outweigh the potential
benefits.

5
PROSTATE CANCER SCREENING
References:
Drazer, M.W., Huo, D. and Eggener, S.E., 2015. National prostate cancer screening rates after
the 2012 US Preventive Services Task Force recommendation discouraging prostate-specific
antigen–based screening. Journal of Clinical Oncology, 33(22), pp.2416-2423.
Duffy, M.J., 2014. PSA in screening for prostate cancer: more good than harm or more harm
than good?. In Advances in clinical chemistry, 66, pp. 1-23. Elsevier.
Heidenreich, A., Bastian, P.J., Bellmunt, J., Bolla, M., Joniau, S., van der Kwast, T., Mason, M.,
Matveev, V., Wiegel, T., Zattoni, F. and Mottet, N., 2014. EAU guidelines on prostate cancer.
Part 1: screening, diagnosis, and local treatment with curative intent—update 2013. European
urology, 65(1), pp.124-137.
McCarthy, M., 2013. Harms of PSA screening outweigh benefits for most men, says American
College of Physicians. BMJ: British Medical Journal (Online), 346, p. 1.
Mühlberger, N., Boskovic, K., Krahn, M.D., Bremner, K.E., Oberaigner, W., Klocker, H.,
Horninger, W., Sroczynski, G. and Siebert, U., 2017. Benefits and harms of prostate cancer
screening–predictions of the ONCOTYROL prostate cancer outcome and policy model. BMC
public health, 17(1), p.596.
Walter, S.D., de Koning, H.J., Hugosson, J., Talala, K., Roobol, M.J., Carlsson, S., Zappa, M.,
Nelen, V., Kwiatkowski, M., Páez, Á. and Moss, S., 2017. Impact of cause of death adjudication
on the results of the European prostate cancer screening trial. British journal of cancer, 116(1),
p.141.