world cancer report - iarc

Fig. 4.39 Poster designed for an annual Prostate
Cancer Awareness Week in the USA.
decrease in prostate cancer mortality has
been recognized in countries where PSA
was widely used in screening different
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162 Prevention and screening
cohorts of men. The decrease in mortality
has become a major subject of discussion.
A community-based randomized trial in
Quebec suggested a mortality decrease of
69% in screened men, which provoked comment
to the effect that a correct analysis by
intention to treat showed no benefit [9].
There is a general expectation that the earlier
detection of prostate cancer inevitably
provides a unique chance for cure. The
understanding of “cure”, however, must
include assessment of the quality of life
experienced by the patient. Compli- cations
currently inherent in the management of
prostate cancer include those associated
with procedures for diagnosis and treatment,
the clear prevalence of over-diagnosis
and the lack of any consensus on the appropriate
treatment. Ultimately, resolution of
many of these matters can only be achieved
on the basis of the results of randomized
controlled trials.
A multinational controlled trial in Europe
has recruited 180,000 men randomized
between diagnosis and treatment in
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support. Prostate, 43: 223-224.
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Group (1999) Rationale for randomised trials of prostate
cancer screening. Eur J Cancer, 35: 262-271.
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screened men versus controls. In the
USA, 74,000 men have been enrolled in a
large controlled trial of screening for
prostate, colorectal and other cancers.
Collaboration between researchers concerned
with these two trials has led to
the development of the International
Prostate Screening Trial Evaluation
Group. The strength of the prospective
planning and coordinated quality control
will provide a sound basis for the scientific
evidence required to answer the
questions posed on the need for large
population-based screening [10]. Currently,
despite more than a decade of
PSA-based screening, the impact of
screening on mortality due to prostate
cancer continues to be controversial,
although some evidence of a decline in
age-adjusted mortality rates for prostate
cancer may be attributable, at least in
part, to screening [11].
WEBSITE
Preventing and detecting prostate cancer (NCI):
http://www3.cancer.gov/prevention/spec_cancer.html#
prostate