Here’s how to orient to address a problem that affects men aged 45 years and over. Europe ‘Man’ is at the forefront in the battle to raise awareness of this neglected disease
Milan, 17 February 2010 – The doubts are part of science, but the citizen is helpless: it must make the PSA test or not? Recall that the PSA is essentially a marker that is detected by a blood test. Does neither good nor bad, obviously. U.S. study questions then what happens after any alarm caused by the marker. Ask a biopsy and then? Opera? Undergo therapy? And if the alarm had reported an anomaly but it does not carry consequences? Humans need a compass to navigate after the findings of U.S. study.
For this reason, the Foundation IRCCS Institute National die Tumour has felt the need to intervene with a statement that is added is consistent with that issued April 16, 2009 by the European Association of Urology (EAU).
We see at a glance what the position is, pointing out that prostate cancer is a major health problem and a major cause of cancer deaths in men. First, it is noted that data from studies published to date are insufficient to recommend in terms of public health policy, the adoption of screening for prostate cancer because of the important effects dell’ over-treatment. Do the screening means to put an entire healthy population to diagnostic tests such as PSA (low risk and low socio-economic and psychological costs) in order to detect early onset of cancers when they can be treated. Not propose mass screening does not mean giving up any attempt to make a policy of prevention. What he says in the PSA is a warning sign, a clue, not proof of the presence of a tumour.
If it is a tumour off the alarm, should be able to distinguish aggressive tumours from non-aggressive. But the current method of screening does not permit, early on, to make this distinction. There are little or not at all aggressive tumours that can not develop over the life of the person, others to conduct intermediate and other high-aggression but require drastic treatments. There is a risk of sovradiagnosi that is to see evil worse than what it is.
The sovratrattamento: the preoccupation of the European Association of Urology is clear: in the Western world, the countless diagnosis (in 2005 in Italy 43,000 new cases: every 12 minutes someone in this country receives a diagnosis of prostate cancer) has always followed – rare are the exceptions – the proposal for a curative treatment even when the tumour shows characteristics of non-aggression. And surgery, Brach therapy, external beam radiation therapy are treatments that can cause significant degradation of quality of life of the person, such as incontinence and impotence.
Avoid over-treatment with diverse strategies, including programs such as active surveillance; therefore, means to identify and select patients deserve a specific immediate treatment and those susceptible to a possible eventual deferred treatment, i.e. to ensure that over-diagnosis leads to excessive, indiscriminate, unnecessary treatments. This is the risk of sovratrattamento.
Active surveillance: here the fundamental issue. Urologists (EAU) recognize both the benefits of screening, because the early warning reduces mortality, and the negative effects of sovradiagnosi that the sovratrattamento. Must be found, waiting to discover diagnostic and prognostic markers more accurately, an approach that still allows us to reduce the mortality (in Italy every year 9,000 people die for this type of cancer). The advice to physicians, particularly urologists, is that they should avoid sovratrattamento, developing safe methods of monitoring and observation of the tumour without the use of invasive therapies. These should be customized according to the needs of patients and according to the prognosis of cancer diagnosed.
Risks and benefits: the advice to men who want to undergo PSA testing and prostate biopsy is possible to obtain information on the risks and benefits of screening and assessment of individual risk. To not bring him short, the first alarm, the decision to drastic action. To this end the European Association of Urologists promotes awareness of the possible treatment for patients suffering from prostate cancer in collaboration with Europe Uomo, the European organization to support patients through the development of information materials and guidelines.
Tags: Cancer, cancer of the uterus, prostate cancer
