Published: Less than 10 min ago
Despite the fact that prostate cancer is the most common form of cancer in Sweden, there is no national screening program. But the problem that stopped a screening program may now be solved, a new study shows.
The fact that there is no national screening for prostate cancer, which alone accounts for around a third of all cancer cases in the country, has its explanation.
Many times harmless tumors are found, which will never pose any danger, but which lead to unnecessary cancer reports and treatments that can cause side effects such as impotence and urine leakage.
This has so far caused the National Board of Health and Welfare to – to the chagrin of some – flatly say no to a screening program similar to that for women to find breast cancer.
The usual approach to detect tumors in the prostate is for the man to provide a blood sample. If it shows elevated values of the substance PSA (prostate-specific antigen), tissue samples are taken to determine whether it is cancer. But the PSA test is too unspecific and the disadvantages outweigh the advantages, the National Board of Health and Welfare believes.
Therefore, there is an intensive search for ways to refine the diagnostics.
Gentler sampling
One possible way is to add an examination with a magnetic camera of the prostate, which has now been tested in a large study from the University of Gothenburg. There they also looked at whether it is possible to take samples from the prostate in a gentler way.
Just over 37,000 men between the ages of 50 and 60 living in the Gothenburg area were invited to PSA testing during the years 2015–2020. In the event of an elevated PSA value (over 3), an MRI examination was offered. About a handful of the invited men attended, and were divided into two groups.
In one group, the method that is standard in most hospitals was used, namely taking many tissue samples from the entire prostate. And if the MRI scan showed signs of cancer, a few more samples were taken from the suspicious area.
In the second group, instead, only samples were taken from the suspected area of cancer. The aim was to see if you can pick up fewer harmless tumors, while still finding the malignant ones.
And very true – the addition of magnetic resonance imaging reduced the risk of finding harmless tumors by a substantial margin, according to the results presented in the New England Journal of Medicine.
– It is a huge progress. Because this has been the big dilemma – that the majority of the ones that we’ve found with the PSA test have been quite harmless, or very slow-growing tumors, that probably would never have been detected. So we have made many men patients unnecessarily, says Jonas Hugosson, professor of urology at the University of Gothenburg and senior physician at Sahlgrenska University Hospital, who was responsible for the study.
Disagreement about tissue samples
According to the researchers behind the study, the results show that sampling suspicious areas is sufficient, although the detection of tumors was delayed in a small proportion of patients. However, these tumors were not judged to be life-threatening, as long as they are closely monitored to see that they do not develop and become dangerous, say the researchers.
However, not everyone makes the same assessment. Henrik Grönberg, professor of cancer epidemiology at the Karolinska Institutet, published a study last year about magnetic cameras as an addition to PSA testing. He thinks it is better to take tissue samples of the entire prostate if the MRI shows signs of cancer, to detect more cases at an early stage.
– The disadvantage is that you then find a little more of the “kind” tumors, but I think that is outweighed by the fact that you also find more of those that require treatment, he says.
According to Jonas Hugosson, the tumors that are missed by only sampling the suspicious area will not fall through the cracks, but will be followed up two years later.
– It doesn’t have to be a disadvantage that we don’t find those tumors extremely early, it can even be an advantage there too – to find them when they get a little bigger, he says.
“Now we have the tools”
Whether a screening program becomes a reality in the future is up to the National Board of Health and Welfare to decide. The last time the authority raised the issue was in 2018, and then it ended in a no.
– To save the life of one man, ten must be diagnosed. That’s pretty high. If you can reduce that quota and get down to five, six, you are on the same numbers as breast cancer screening. Then I think the National Board of Health and Welfare will value prostate cancer screening in a different way, says Jonas Hugosson.
Since prostate cancer often does not show symptoms until a late stage, when it is difficult to cure, universal testing of apparently healthy men is the only way to reduce the mortality rate of the disease, says Henrik Grönberg.
With the progress that has been made in the field in recent years, he thinks that there are now good enough methods to introduce a general screening, where you routinely call all men in a certain age group.
– Yes, that is my position. Now we have the tools for it.
Facts
Prostate cancer
Prostate cancer is Sweden’s most common form of cancer. The disease mainly affects older men, around half are over 70 years old. Around 10,000 new cases are discovered each year.
Approximately 2,200 Swedish men die from the disease during a year.
Cancer in the prostate means that a cancerous tumor has formed. At first it only grows inside the prostate gland and is not noticeable. It can take up to 10 to 15 years before the tumor spreads or causes symptoms.
Symptoms that may indicate prostate cancer are frequent urination, delayed urination, a weak stream of urine and blood in the urine.
Source: Cancer Foundation, 1177.se
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