Ethical Controversy Over Prostate Cancer Screening

Before having a test for prostate cancer, men should be informed about the lack of accord among doctors on screening and treatment, said Fritz H. Schroder, professor and chair of the department of Urology, Erasmus University (Rotterdam, The Netherlands), in a presentation to the European Cancer Conference (ECCO) in Lisbon (Portugal).

Most men die from some other disease than prostate cancer. However, in 1996, prostate cancer accounted for more than 55,000 deaths in the European Union and is the third most common cause of cancer death among UK men. In general, the higher a man's prostate-specific antigen (PSA), the greater the chance of cancer. What makes PSA testing controversial is that some men with prostate cancer do not have high PSA levels, while two-thirds of men with higher levels of PSA do not have prostate cancer.

Current treatment options when the disease has not spread to other parts of the body include surgical removal of the prostate, radiation therapy, or watchful waiting. Although research has not yet established if one option is better than another, the availability of testing in the United States has led to a large increase in radical prostatectomy and to a greater use of radiotherapy.

Prof. Schroder says only research data will provide an accurate analysis of risk benefit and cost. Until then, doctors should explain why prostate screening is controversial. "Testing without providing this information is unethical,” he notes. "Meanwhile, powerful, early diagnostic tests cannot be withheld from well-informed men. The accent here, however, has to be on well-informed.”