Resumen de EDITORIAL COMMENT:: Prostate cancer: to screen or not to screen.
Bailey and Brewster in their very timely manuscript discussed the current status of PSA-based screening for prostate cancer (PCa). Upon review of the pertinent literature, the authors concluded that available data suggests at best a moderate impact of PSA screening on prostate cancer mortality at the expense of a high risk of over-diagnosis and unnecessary treatment. Unfortunately, two recent randomized controlled clinical trials complicated the issue by their conflicting results (1,2). However, both trials suffered from methodological flaws. In PLCO trial, despite the inclusion criteria, the usual care (control) arm was estimated to have a 52% contamination rate due to PSA screening by year 6. As the authors rightly stated, this may have the potential of creating a control arm of the PLCO which was equivalent to ERSPC. Thus PLCO was rather a comparison of heavily screened population versus less heavily screened one. Additionally, evidence emerging from the literature indicates that several confounding factors (such as comorbidity) were unaccounted for in these trials and better selection for further management may be possible, thus avoiding over-treatment and associated side effects...
