Recommendations of the Brazilian Society of Urology and the early detection of prostate cancer

In recent days, the whole world was surprised by the news published in the lay and medical press about the validity of the examination PSA to detect prostate cancer at an early stage in men after the 5th decade of life and not showing symptoms associated with tumor .

The authorship of this alarming statement was an American Medical Association U.S. Preventive Task Force, arguing that rising levels of PSA in the blood may suggest cancer and guide biopsies whose results are negative in more than 70% of cases. It also states that biopsies may be complicated (eg, local infection) and that positive results can mean low-risk cancer surgical treatment or radiotherapy (most effective) would be dispensable, thus avoiding cost and possible side effects (impotence and rarely, urinary incontinence). Finally, advocates the creation of urological examination including digital rectal examination (touch) and serum PSA only in symptomatic patients, ie, urinary disorders, poor general condition, bone, etc.. This last argument receives scathing critique of the medical community because it is well established that the diagnosis at this stage with symptoms generally have advanced neoplastic disease and is characterized with lower chances of cure and / or control.

The orientation of the U.S. Preventive Task Force received immediate global response by the major urological societies, including the American Urological Association (AUA) and European Association of Urology (EAU), who considered that this guidance has made a huge disservice, inappropriate and irresponsible towards the male population after 50 years, especially those at higher risk for this cancer, or a family history of prostate cancer and offspring of the black race. It should be noted also that a significant number of men get cancer, for many reasons without belonging to any of the risk groups mentioned.

The most consistent arguments for conducting systematic PSA testing and urologic evaluation in men with good life prospects include:

- The existence of clear evidence that early diagnosis of prostate cancer, especially in the asymptomatic phase, allows a cure for cancer, or .... saves lives.

- Recent study by the European Randomized Study of Screening for Prostate Cancer (ERSPC), which included thousands of men to follow-up period longer than 10 years, dividing them into two groups: those who underwent systematic testing of PSA versus those who could observation and examination performed only when symptoms of PSA. In the first group, the results showed a decrease of deaths directly related to cancer by 21%! To have a dimension of the problem should be noted that this tumor is most common among men after 50 years in various regions of America and Europe, and the second cause of cancer death.

It is well known that prostate tumors have similar aggression, but there are clear indications that suggest the appropriate treatment, without much delay, in cases of tumors that have some characteristics, for example, cells with marked differences in relation to normal cells, large tumors, invasive and / or local area, etc.. Thus, with this information, it is the urologist, in agreement with the patient, choose the best approach - surgery, radiotherapy, alternative treatments or just system of continuous observation in the cases considered low aggressiveness or invasive treatment which may be unsuitable for that patient.

The Brazilian Society of Urology is associated to this global response against these guidelines and the U.S. Task Force recommends periodic assessment of men, even asymptomatic after 45-50 years, seeking to identify tumors at an early stage, whose chances of cure is very large.

Please note that the elevation of PSA does not necessarily mean prostate cancer. Other medical conditions can change their values, including benign prostatic hyperplasia, prostatitis, trauma, etc.. The urologist, based on information related to complaints, physical examination (touch) and laboratory is fully capable of clarifying the diagnosis, decide on biopsy and offer the best direction.

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