Crikey’s concerns about the over-hyping of prostate cancer screening last week (raised in Simon Chapman’s “The pointless hyping of prostate cancer“) have drawn an interesting and important response from Canberra infectious diseases specialist Professor Peter Collignon:
I think there is another major issue that needs to be considered when prostate screening is recommended for a population. That issue is how many cases of infection, especially severe infections, may result from the screening programs.
If we do Prostate Specific Antigen (PSA) screening on a population, you then need to act on the results if the PSA is raised. That invariably means doing prostate biopsies.
Prostate biopsies however have risks that include serious infections. There are quite a number (likely a few per cent that develop infections of their prostate or urinary tract after a biopsy. Some of these are minor but others can lead to prostatitis, which can become chronic in some people. More serious infections however are blood stream infections. Around 0.5 per cent to 1 per cent of prostate biopsies result in septicaemia (even after prophylactic antibiotics) and people still die from septicaemia. Probably only about 10 per cent of those who have bacteremia die as a result, but most of those that survive are still very sick, many needing ICU admissions.
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Most prostate biopsies are also likely to be done on those without prostate cancer (as most PSAs that are raised but not at very high levels in a mass screening population are likely to be false positive results — abnormal PSA results which turn out not to reveal cancer). It needs also to remembered that even in those with prostate cancer, the disease may be so indolent they would not get problems for another 10 or 20 years — as opposed to death or immediate morbidity from sepsis or other complications (eg bleeding) from a prostate biopsy or an operation!
If mass screening programs are recommended, we need to make a major effort to look at not only the benefits but also the complications that are likely to result from the screening tests looking for cancer (including the prostate biopsies) and also what complications occur from the resulting surgery/ radiotherapy/drug therapy etc in those with cancer. We need to not only weigh up how many extra years of life the surgery/radiotherapy itself may help produce (which may not be many in the elderly population) but the social costs of intervention (such as rates of impotence and incontinence after surgery etc).
I think so far the issue of serious infections such as septicaemia that can result not infrequently from prostate biopsies, does not seem to have been factored into this risk/benefit discussion very much.