Japanese Journal of Clinical Oncology Advance Access published online on April 4, 2009
Japanese Journal of Clinical Oncology, doi:10.1093/jjco/hyp025
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© The Author (2009). Published by Oxford University Press. All rights reserved
The Japanese Guideline for Prostate Cancer Screening
1 Cancer Screening Assessment and Management Division, Research Center for Cancer Prevention and Screening, National Cancer Center
2 Department of Cancer Control and Statistics, Osaka Medical Center for Cancer and Cardiovascular Diseases
3 Department of Thoracic Surgery, Kanazawa Medical University
4 Cancer Information Services and Surveillance Division, Center for Cancer Control and Information Services, National Cancer Center, Tokyo, Japan
For reprints and all correspondence: Chisato Hamashima, Cancer Screening Assessment and Management Division, Research Center for Cancer Prevention and Screening, National Cancer Center, 5-1-1 Tsukiji Chuo-ku, Tokyo 104-0045, Japan. E-mail: chamashi{at}ncc.go.jp
Received November 7, 2008; accepted March 9, 2009
In 2005, there were 9264 deaths from prostate cancer, accounting for 4.7% of the total number of cancer deaths in Japan. As the population continues to age, interest in prostate cancer screening has increased, and opportunistic screening for prostate cancer has been conducted worldwide. The guideline for prostate cancer screening was developed based on the established method. The efficacies of prostate-specific antigen (PSA) and digital rectal examination (DRE) were evaluated. Based on the balance of the benefits and harms, recommendations for population-based and opportunistic screening were formulated. Two methods of prostate cancer screening were evaluated. Based on the analytic framework involving key questions, 1186 articles published from January 1985 to October 2006 were selected using MEDLINE and other methods. After the systematic literature review, 28 articles were identified as providing evidence of mortality reduction from prostate cancer, including 5 observational studies for DRE screening, 1 meta-analysis, 3 randomized controlled trials and 19 observational studies for PSA screening. Although several studies showed that PSA screening had a beneficial effect, the results of the selected studies were inconsistent. Overall, the evidence that screening reduced mortality from prostate cancer was insufficient. Furthermore, prostate cancer screening is associated with serious harms, including overdiagnosis, adverse effects of needle biopsy and adverse effects of local prostatectomy. At present, the evidence for the effect of prostate cancer screening is insufficient. Both PSA and DRE were not recommended for population-based screening programs, but they could be conducted as individual-based screening if basic requirements were met.
Key Words: prostate cancer • cancer screening • guideline • recommendation • prostate-specific antigen • digital rectal examination