Screening for prostate cancerBMJ 1997; 315 doi: https://doi.org/10.1136/bmj.315.7101.186b (Published 19 July 1997) Cite this as: BMJ 1997;315:186
Randomised trials of treatment in early disease are important
- Rowan H Harwood, Consultant physiciana
- a University Hospital, Nottingham NG7 2UH
- b Division of Urologic Surgery, Washington University School of Medicine, St Louis, MO 63110, USA
Editor—The debate about the desirability of screening for prostate cancer as outlined in the editorial by Steven H Woolf has centred on the ability to detect, and then cure, localised disease.1 Early detection is certainly possible, albeit at a cost. Whether early radical treatment can cure the cancer remains to be seen.
Cure is not the only objective of cancer care, however. Prolongation of life and improvement in the quality of life in the absence of cure are also valuable. In the case of prostate cancer, improving the quality of life translates into delaying the appearance of metastases and local symptoms and avoiding iatrogenic morbidity. Radical surgery or radiotherapy may delay metastatic spread and retard localised disease but we do not yet know. Since the recent publication of a randomised trial by the Medical Research Council in the British Journal of Urology,2 however, the statement that there is no evidence that early detection improves outcome needs to be expanded on.
Early androgen deprivation improves outcomes for patients with locally advanced …