Vroegdetectie van prostaatkanker bij de geïnformeerde gezonde man

Abstract

Early detection of prostate cancer in the informed, healthy man In 2018, 107,000 men died of prostate cancer in the European Union. Prostate cancer is not a trivial disease and accounts for more than 10% of all male cancer deaths. Most men are not aware that it is possible to have asymptomatic prostate cancer and they are usually not informed about the existence and value of prostate-specific antigen (PSA) testing. Early detection of prostate cancer clearly reduces prostate cancer mortality and provides the opportunity to be cured relatively easily without insurmountable side effects and at a relatively low cost. Advanced prostate cancer is associated with more morbidity that significantly reduces the quality of life. In addition, there is a real risk of metastasis and castration-refractory disease (that is extremely expensive to treat) and eventually death. Opponents of PSA screening denounce the overdiagnosis and overtreatment of non-lethal prostate cancer. This debate has led in many countries to a decrease in PSA testing, resulting in an increase of cases with advanced prostate cancer as well as in cancer mortality rates that were declining almost everywhere in recent years. This opinion paper discusses today’s diagnostic tools as well as the results of clinical studies on early detection, the problems related to PSA testing and the benefits of early detection with the current scientific guidelines. In summary, PSA can be used today to prevent informed men from developing too far advanced disease, thereby improving the quality of life and reducing the healthcare system costs without missing out on significant prostate cancers.