có tin tưởng psa tầm soát ?

[tvnguyen]

Key Findings From ERSPC
In the ERSPC, 182,000 men between the ages of 50 and 74 years who resided in 7 different European countries were randomized to either PSA screening, at an average of once every 4 years, or to a control group. The predefined core age group for the study consisted of 162,243 men aged 55 to 69 years, and the primary outcome for the study was rate of death from prostate cancer. Mortality follow-up was completed on December 31, 2006.
The average and median follow-up times were 8.8 and 9 years, respectively. These are the key findings of the ERSPC:
• There were 214 prostate-cancer-related deaths in the screening group and 326 deaths in the control group in the core age group.
• The cumulative incidence of prostate cancer was 8.2% in the screening group and 4.8% in the control group.
• PSA screening was associated with a significant absolute reduction of 0.71 prostate cancer deaths per 1000 men after an average of 9 years.
• To prevent 1 prostate cancer death, 1410 men would have to be screened and an additional 48 men would require treatment.
• An analysis of participants who actually underwent screening during the first round provided a rate ratio for prostate-cancer-related mortality of 0.73 (95% confidence interval, 0.56 to 0.90).
This study has a number of limitations that deserve serious consideration, according to Mary McNaughton-Collins, MD, a general medicine internist and health services researcher at Massachusetts General Hospital and Harvard Medical School, in Boston, who participated in the round-table discussion but was not involved in the study.
One of the limitations is that the trial pulled together studies conducted in different countries, and since protocols were different, it wasn't a uniform study design, Dr. McNaughton-Collins noted.
In addition, this is the third interim analysis, she pointed out. So the "20% mortality reduction is only marginally statistically significant at 0.04, raising the question: Why stop now?"
The numbers needed to treat and screen are high, and this is problematic, she said. "For right now, we should probably maintain a healthy skepticism about this type of screening program," she commented. "Any effective screening program, we know, requires more than just effectiveness. We have to find out more about quality of life or cost-effectiveness."

[admin]

1. The essayists also note that although evidence indicates that breast cancer screening saves lives, 838 women, aged 50 to 70 years, must undergo screening for 6 years to avert 1 death. However, this 1 life saved generates "thousands of screens, hundreds of biopsies, and many cancers treated as if they were life-threatening when they were not,".
2. "Information about risks of screening and biopsy should be shared with patients before screening,". in prostate cancer, low-volume lesions with low Gleason scores have a low-risk for death. Minimal-risk disease should not be called cancer; it should be called indolent lesions of epithelial origin (IDLE),
3. Finally, a greater emphasis on prevention, including the use of proven cancer preventive agents, such as finasteride for preventing prostate cancer and tamoxifen and raloxifene for preventing breast cancer, is needed.
Sum: An estimated $20 billion is spent to screen for prostate and breast cancer in the United States. The essayists call for 10% to 20% of that amount to be invested in an effort to improve screening.

http://www.medscape.com/viewarticle/...e&uac=117806HN

[nhuocgiang]

Khám Tiền liệt tuyến ngã trực tràng cũng gây tăng PSA

[admin]

"PSA screening cannot differentiate between indolent and lethal prostate cancer,"
Change is clearly in order, suggested a spokesperson for the American Urological Association (AUA). "A complete cultural overhaul is needed to change the perception that all prostate cancer needs to be treated,"
The change will require physician "re-education" and the consideration of active surveillance as an alternative to treatment, he said.(http://www.medscape.com/viewarticle/...&uac=117806HN)