Question

A screening program for the early identification of prostate cancer would be what type of prevention? Explain and describe how the various approaches to intervention apply to preventive healthcare and population health strategies.

Answer 1

Ans) Lifestyle modifications like smoking cessation and exercise can decrease the risk of developing prostate cancer. 5α-reductase inhibitors, although associated with an increased number of high-grade prostate cancers, reduce overall prostate cancer burden.

- In absence of any detrimental effect on survival, these agents can be cost-effective in prostate cancer prevention. Several other pharmacological agents, e.g. aspirin appear promising and need further evaluation in clinical trials; many such trials are already underway.

- While PSA screening remains a controversial topic, overdiagnosis associated with PSA screening can be minimised by one or several modifications like changes in the PSA threshold, frequency of screening, and addition of other biomarkers like Kallikrein panel, free-PSA.

- Prospective evaluation of these should remain among top research priorities. The role of newer biomarkers like urinary PCA3 and TMPRSS2-ERG assays also appears promising and needs further evaluation in screening setting. Similarly, newer methods to distinguish aggressive prostate cancers from indolent cancers diagnosed during screening are needed and biomarkers like Ki67, CCP or imaging methods like mp-MRI need further prospective evaluation so that these can be incorporated in management algorithms to minimise overtreatment.