La controverse du dépistage du cancer de la prostate

Selon le Groupe de travail des services préventifs aux USA, l’APS ou le dépistage régulier de l’antigène prostatique réduit le risque de surdiagnostic. Par conséquent, il limite le danger d’un excès de traitement. Toutes fois, la réduction des risques intermédiaires ou élevés du cancer de la prostate suscite l’inquiétude des urologues en raison d’éventuels retards de diagnostics chez les hommes atteints de la pathologie et qui peuvent entre temps bénéficier d’un traitement.

Il est à rappeler que le cancer de la prostate demeure la deuxième cause de décès chez les hommes. En outre, un rabais du nombre des décès par cette tumeur a été enregistré depuis l’avènement de l’APS en 1980. Cependant, la radiothérapie et la chirurgie ont un impact négatif sur la qualité de vie des patients.

L’apport de l’examen de dépistage exige la prise en compte de l’association des complications engendrées par les traitements de la pathologie avec les avantages douteux du PSA. Par conséquent, il est à conclure que les potentiels effets indésirables du dépistage régulier l’emportent sur les avantages.

Par ailleurs, la diminution de l’utilisation des tests de dépistage dans les institutions de santé incite les urologues à se concentrer sur l’incidence totale des cancers de la prostate. Ils ne peuvent pas confirmer s’il y a eu une baisse du nombre d’incidents depuis la publication des directives du Groupe de travail des services préventifs.

Les chercheurs ont évalué l’effet des recommandations de l’USPSTF sur le nombre et la répartition des nouveaux diagnostics des cancers de la prostate aux États-Unis. Ils ont repéré le développement de nouvelles tumeurs entre 2010 et 2012.

Cette étude a permis d’une part de quantifier les avantages potentiels et les torts causés par le surdiagnostic ainsi que les risques de maladies chez les hommes âgés, d’autre part, déterminer les risques majeurs d’un diagnostic décalé.

Les fluctuations de cette pathologie

Tous les types de cancers de la prostate ont diminué de façon significative, mais les nouveaux diagnostics de maladie non localisée n’ont pas changé. Les diminutions étaient semblables dans tous les sous-groupes d’âge, de comorbidité, de race, etc.

L’étude a montré qu’après 12 mois de la publication des instructions de l’USPSTF les diagnostics de nouveaux cancers à faible risques avaient diminué de 37,9% et continuaient à diminuer plus rapidement que les autres strates de risques.

L’étude a également identifié une baisse de 28,1% dans les diagnostics de maladies de cancer de la prostate à risques intermédiaires. Tandis que les cancers de prostate à risques élevés ont eu une chute de 23%.

La recherche devrait se concentrer sur les paradigmes de dépistage du cancer de la prostate qui à la fois limite les méfaits et amplifie les potentiels avantages du dépistage ainsi que la comptabilité pour les facteurs de risque et les préférences individuelles du patient.

2 181 thoughts on “La controverse du dépistage du cancer de la prostate

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