Prostate cancer is the most common form of cancer in Sweden and accounts for almost 17% of all cancers. Each year diagnosed of 10,500 men in Sweden for cancer of the prostate. 2.400 men die each year. Prostate cancer is the most common cause of death by cancer in men.
the New research at the university of Gothenburg shows that the deaths from prostate cancer is reduced by around 30 per cent in the organised and regular PSA screening. In the study has 10,000 men, invited for PSA testing every two years. The men were followed for 22 years.
" This is really no jättenyhet for us, but rather something we expected. Among other things, on the basis of a large european screeningstudie which has been ongoing for many years, " says Maria Frånlund, phd in urology at the Sahlgrenska academy, university of Gothenburg and chief physician at the university hospital.
highlight the results of the study about the men who die despite the fact that they are with in an organised and continuous screening programmes.
" What we saw was that the men who went in late in the program, after 60, had an increased risk for prostate cancer. Many of these men already had disseminated disease in the body and treatment does not cure the cancer.
the Study could also show that men who after having taken part up to the upper age limit, 70 years, later fell ill and died of prostate cancer. In other words, it is too early to stop screening healthy men already at the age of 70. The danger is not over then, says Maria Frånlund.
" you should introduce a screening programme in Sweden, so it is important to also look at when to exit the screening. Before you dismissed the people over 70 years of age, believe that the average age is getting higher and many are healthy way up in years, " she says.
prostatascreening, similar to the who since the 1980s are available for breast cancer in women, has been debated for a long time. A PSA test is a blood test that can give a signal about prostate cancer long before any symptoms go to discover. Despite the fact that, although earlier studies demonstrated the positive effects of organised screening programmes, said the health Board as late as last year not to recommend a national screening program.
for About half of all men who get diagosen after the screening has really a harmless cancer, and are likely to be treated unnecessarily.
the main Reason is that the benefits of screening for prostate cancer using only the PSA test does not clearly outweigh the negative effects at the population level, according to the health Board.
– It is a very complex issue. An elevated PSA value can mean that you have a high risk for cancer, but can also be a sign that you have a benign growth of the gland. Then there are men with low values, which may develop an aggressive cancer in all cases, " says Maria Frånlund. But the biggest problem is that prostate cancer can look so different in different men, and about half of all men who get diagosen after the screening has really a harmless cancer, and are likely to be treated unnecessarily.
In Sweden there is today no national recommendations on the prostatascreening. Nor internationally has PSA screening been. According to Maria Frånlund are only two countries in the world – Kazakhstan and Lithuania – which have national screening programmes for prostate cancer.
instead, up to each man in the riskåldern to decide if he wants to test themselves or not. According to Maria Frånlund test, almost half of all men over 50 on its own initiative. But it looks very different in different regions.
– the Problem with disorganized sampling is to completely the wrong people can test themselves, it is not done in a structured way and it gets very unequally. Many men will receive a poor follow-up. It is also costly to society, and the benefits are difficult to analyze.
" We believe it would be more advantageous to organize this somehow, so that all men have the same conditions. But it is a political issue, " she says.Maria Frånlund, md. Photo: Andreas Broqvist
It was precisely to increase the understanding of the effect of screening and discuss how a future screening programmes could be designed that was the main objective of Maria Frånlunds thesis. She says that there is a great deal of uncertainty, both in care of the national Board of health, on how to handle the men in riskåldern for prostate cancer.
" It is because we need a complementary test to PSA, which enhances the diagnostic. PSA-tests, we can find many harmless tumors, which would not give some troubles. If we have not found them, would the patient have been blissfully unaware. We can't determine which have a harmless cancer and who have the aggressive form.
operated on unnecessarily. An additional problem is that prostataoperationerna is complicated and can have serious side effects. The prostate gland sits cumbersome to and are anatomically difficult to access. There is a risk that the sphincter and potensnerver damaged.
the Majority of men who undergo surgery, over 80 percent, suffer some degree of reduced erektionsförmåga. Many will be totally impotent for the nerves is damaged. And 20-25% of men have problems with urination and urine leakage.
"It's not so fun if you are 60 years and may go with a blöjskydd the remaining life, after to have removed a cancer that was completely harmless," says Maria Frånlund.
But progress is in spite of everything forward. The mortality rate of prostate cancer has dramatically fallen over the last 15 years with the help of former diagnostistik and better treatment.
the prostate gland is enlarged is absolutely not the same thing as cancer. Many confuse the concepts.
Maria Frånlund says that targeted cervical smear tests with mri can be a method to make prostatadiagnostiken more just. It would also lead to fewer side effects.
" We are pushing hard to this type of operations to be done on the so-called högvolymcenter, where each surgeon who works makes at least a hundred procedures per year, so that you become good at it. Then we see that the side effects decrease significantly, " says Maria Frånlund.
According to Maria Frånlund have 30 to 40 per cent of men in their 60s trouble with urination. It is quite natural, since the prostate grows with age. A previous study at the Gothenburg university have looked at whether men with elevated PSA values and difficulties emptying the bladder, or the need to urinate often, had a higher risk of prostate cancer.
– There are many who believe it, but we clearly saw that it was the other way around. The men who had the type of symptoms and elevated PSA had a lower risk of prostate cancer.
– The higher PSA values in these men exhibit is conditioned by the fact that they have a benign prostatic hyperplasia. To the prostate gland is enlarged is absolutely not the same thing as cancer. Many confuse the concepts.
Maria Frånlund do not believe in the current solution where individual men on their own authority goes and takes a sample every now and then.
" Based on our findings in the study, this should be structured. I think that you should have a national consensus on what should be done.
– Should you press the start button for general screening, then you should be clear as to just how to do. At what age begins the screening and when should it finish?
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