Is this, however, a real disease that will eventually strike any man who lives long enough? Or are we simply testing too many men for no apparent reason?
Prostate cancer screening has long been a contentious issue. Should healthy men with no symptoms or a family history of prostate cancer get a PSA test and treatment right away if a tumor is discovered?
The PSA test has been the gold standard in prostate cancer screening for over 30 years. This simple and widely available blood test determines the amount of prostate-specific antigen in the blood. The PSA test may detect cancers that are rapidly growing and have the potential to spread to other parts of the body and would benefit from treatment. It may also detect cancers that grow slowly and are unlikely to be harmful. Some men choose to have regular PSA tests even if they have no symptoms of prostate cancer. However, PSA tests are not without flaws. PSA levels can be elevated when there is no cancer and low when there is cancer.
Proponents of routine PSA testing contend that it is the most effective screening tool for detecting prostate cancer early, when it is most treatable. Some argue that it leads many newly diagnosed men to seek invasive treatments that can cause a variety of side effects, including incontinence and impotence, despite the fact that up to 80% have low-risk tumors that will never be life-threatening. For them, the best option is active surveillance and watchful waiting, in which doctors closely monitor patients for signs of cancer progression before treating them. Regular follow-up in active surveillance can include blood tests, rectal exams, and prostate biopsies to monitor cancer progression. If tests show that the cancer is progressing, cancer treatment such as surgery or radiation may be recommended.
The formal clinical guidelines for prostate cancer screening and treatment from the various relevant clinical societies are constantly changing, fueling this debate. Following two major meta-analysis studies (the European ERSPC and the American PLCO), the US Preventive Services Task Force (USPSTF) issued guidelines against routine PSA tests in the early 2000s. However, due to revisions to the leading studies and the publication of new data, the USPSTF removed this recommendation in 2018, while the parallel Canadian task force, for example, maintained its objection.
Prostate cancer is the third most common cancer disease in Israel, and the most common cancer among men, as it is worldwide. In 2018, 2,713 Israeli men were diagnosed with prostate cancer, with 416 dying as a result of the disease. In Israel today, 30,278 men have been diagnosed with prostate cancer since 1990, with 10,057 diagnosed in the last five years.
In terms of morbidity and mortality, Israel ranked 58th in the world in 2020. This large disparity in morbidity and mortality factors, combined with a high survival rate of 97%, may indicate that over-screening occurs in Israel as well.
The growing prevalence of prostate cancer is driving the global market for prostate cancer therapeutics. In 2021, the global market was valued at $24.9 billion, and it is expected to exceed $24.9 billion by 2030. The rising number of cases of prostate cancer can be attributed to the market's expansion. Rapid technological advances in oncology have resulted in the early detection of prostate cancer among patients. This factor is likely to be the driving force behind the market's significant growth opportunities. There has also been a significant increase in private and public sector investment in Israel and around the world.
Any individual man, in my opinion, requires a personalized, patient-centered approach to screening and treatment that one-size-fits-all screening guidelines do not take into account. Based on the patient's age, family history, health, lifestyle, race, ethnic background, and other factors, the treating physician should determine what is best for him.
If the patient does have a medium or high-risk cancer, early detection may benefit him. Radiation side effects of rectal toxicity, such as rectal pain and bleeding, chronic diarrhea, urinary urgency and incontinence, cystitis, proctitis, and erectile dysfunction, can affect up to 35% of patients undergoing prostate radiation therapy. Some of them will experience chronic side effects that will have a significant impact on their quality of life.
https://www.yicare-medical.com/rapid-test/prostate-specific-antigen-rapid-test-device.html