Published by Oxford University Press on behalf of the International Epidemiological Association © The Author 2007; all rights reserved.
Commentary: Prostate cancer is omnipresent, but should we screen for it?
Department of Social Medicine, University of Bristol, UK. E-mail: Richard.martin@bristol.ac.uk
Accepted 20 July 2006
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Introduction |
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In 1935, the pathologist Arnold Rice Rich reported on a study investigating his impression that microscopic prostate cancers could be detected at autopsy more commonly than were being diagnosed clinically.1 This study has been cited 215 times up to July 2006, and along with a 1954 autopsy series reported by LM Franks2 (cited 371 times), made a major contribution to our understanding of the natural history of prostate cancer. Rich's study confirmed his intuition of a large disparity between microscopic prevalence of prostate cancer and its clinical incidence, in contrast with many other solid tumours where these differences are not as marked. This commentary discusses the contemporary relevance of these findings 71 years on, with a focus on their implications for understanding the epidemiology of prostate cancer and its early detection and treatment.
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What were the main findings? |
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There were at least three key findings, and each of these still raise important questions today. Firstly,
What is the prevalence of early prostate cancer?
Is it possible to detect these early cancers in alive men?
Given that many men with these histological prostate cancers die of other diseases, is it worth detecting them?
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Conclusion |
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