Vol. 16 • No. 4 • December 2009 Journal of ANDROLOGICAL SCIENCES Official Journal of the Italian Society of Andrology Cited in Past Editors Editorial Board Fabrizio Menchini Fabris (Pisa) Antonio Aversa (Roma) SCOPUS Elsevier Database 1994-2004 Ciro Basile Fasolo (Pisa) Carlo Bettocchi (Bari) Edoardo Pescatori (Modena) Guglielmo Bonanni (Padova) Paolo Turchi (Pisa) Massimo Capone (Gorizia) 2005-2008 Tommasi Cai (Firenze) Luca Carmignani (Milano) Antonio Casarico (Genova) Editors-in-Chief Carlo Ceruti (Torino) Vincenzo Ficarra (Padova) Fulvio Colombo (Milano) Andrea Salonia (Milano) Luigi Cormio (Foggia) Federico Dehò (Milano) Giorgio Franco (Roma) Editor Assistant Andrea Galosi (Ancona) Ferdinando Fusco (Napoli) Giulio Garaffa (London) Andrea Garolla (Padova) Paolo Gontero (Torino) Managing Editor Vincenzo Gulino (Roma) Vincenzo Gentile (Roma) Massimo Iafrate (Padova) Copyright Sandro La Vignera (Catamia) SIAS S.r.l. • via Luigi Bellotti Bon, 10 Francesco Lanzafame (Catania) 00197 Roma Delegate of Executive Committee Giovanni Liguori (Trieste) of SIA Mario Mancini (Milano) Editorial Office Giuseppe La Pera (Roma) Alessandro Mofferdin (Modena) Lucia Castelli (Editorial Assistant) Nicola Mondaini (Firenze) Tel. 050 3130224 • Fax 050 3130300 Giacomo Novara (Padova) [email protected] Section Editor – Psychology Enzo Palminteri (Arezzo) Pacini Editore S.p.A. • Via A. Gherardesca 1 Annamaria Abbona (Torino) Furio Pirozzi Farina (Sassari) 56121 Ospedaletto (Pisa), Italy Giorgio Pomara (Pisa) Marco Rossato (Padova) Publisher Statistical Consultant Paolo Rossi (Pisa) Pacini Editore S.p.A. Elena Ricci (Milano) Antonino Saccà (Milano) Via A. Gherardesca 1, Gianfranco Savoca (Palermo) 56121 Ospedaletto (Pisa), Italy Omidreza Sedigh (Torino) Tel. 050 313011 • Fax 050 3130300 Marcello Soli (Bologna) [email protected] Paolo Verze (Napoli) www.pacinimedicina.it Alessandro Zucchi (Perugia) www.andrologiaitaliana.it INDEX Journal of Andrological Sciences EDITORIALS PSA-based screening for prostate cancer: a more conscientious behaviour against the tenacity of a early diagnosis V. Ficarra, G. Novara ................................................................................................................................................................................... 147 PSA and male sexual dysfunction A. Saccà, L. Rocchini, A. Salonia, F. Montorsi .............................................................................................................................................. 151 EXPERT OPINIONS The case for “PSA screening”: why being “pro” is mandatory! N. Suardi, F. Montorsi ................................................................................................................................................................................. 154 A complex biology, men’s weltanschauung, and communication challenges M. Maffezzini .............................................................................................................................................................................................. 156 REVIEW ARTICLE Health promotion in women with female genital mutilations J. Abdulcadir, V. Orlando ............................................................................................................................................................................ 159 ORIGINAL ARTICLE Straightening-reinforcing (S-R) technique with selected incisions in the treatment of congenital and acquired penile curvature: 10 years results of a simplification F. Mantovani, R. Anceschi, S. Maruccia, G. Cozzi, V. Guarrella, F. Rocco ...................................................................................................... 165 TABLE OF CONTENTS ............................................................................................................................................................................... 168 EDITORIAL Journal of Andrological Sciences 2009;16:147-150 PSA-based screening for prostate cancer: a more conscientious behaviour against the tenacity of a early diagnosis V. Ficarra, G. Novara Department of Oncologic and Surgical Sciences, Urologic Unit, University of Padua, Italy Prostate-specific antigen (PSA)-based screening for prostate cancer is among the most important and controversial issues of medicine with enormous health-care and health-economic relevance. Weighting the real effect of mass screening on prostate-cancer mortality and estimat- ing the risk of overdiagnosis and overtreatment related to the use of PSA test in asymptomatic men were the most relevant unsolved ques- tions in the last decades. The medical community has waited for many years definitive answers from two randomized controlled trials started in the early 1990s in United States (Prostate, Lung, Colorectal and Ovary [PCLO] trial) and Europe (European Randomized Screening for Prostate Cancer [ERSPC] trial), respectively. During such time, the availability of a “simple” and “safe” test to yield an early diagnosis of prostate cancer forced many urological and oncological societies to recommend period- ical dosages of PSA in asymptomatic men over 50 years. For example, in the USA, both American Urological Association 1 and American Can- cer Society 2 recommended that screening should be offered to men of 50 years or older. More recently, the National Comprehensive Cancer Network (NCCN) practice guidelines concerning the prostate cancer early detection suggested considering to offer baseline DRE and PSA dosage at the age of 40 years 3. In other words, waiting for the results of the two ongoing randomized controlled trials (RCTs) on prostate cancer mass screening, we assisted to the affirmation of the opportunistic PSA screening with the progressive lower of the cut-off points for “normality” and of age to start dosing PSA. Surely, this trend had larger fortune and impact in the clinical practice that the opposite recommendations of some other scientific societies. Specifically, the US Preventive Services Task Force (USPSTF) had concluded that the evidence was insufficient to recommend for or against PSA screening 4 and the Advisory Com- mittee on Cancer Prevention in Europe had stated that screening for prostate cancer was not recommended as health-care policy 5. During these years, all the urologic community was hoping that the Key words evident harms related to the screening could be balanced by the con- Prostate cancer • PSA • Screening vincing evidence of significant reduction in cancer-specific mortality. Corresponding author: Vincenzo Ficarra, Department of Oncologic and Surgical Sciences, Urologic Clinic, University of Padua, via Giustiniani 2, 35100 Padua, Italy – Tel. +39 0498212720 – Fax +39 0498218757 – E-mail: [email protected] 147 V. Ficarra, G. Novara In a recent issue, the New England Journal of protocol was 85%, slightly below the value of 90% Medicine published the first reports of both ongo- planned during the design of the study. Vice versa, ing RCTs evaluating the effects of prostate cancer the contamination rate in the control group (i.e., the screening on cancer-specific mortality 6 7. Unfortu- percentage of patients randomized to the control nately, although both studies are still ongoing and arm which, indeed, received PSA testing) ranged future updates were promised, their preliminary con- from 40 to 52%, which was significantly higher than clusions seem to be different. the pre-planned 20%. On the whole, however, only The results of PCLO trial showed no mortality benefit 174 prostate-cancer deaths were observed and driv- from combined screening with PSA and digital rectal ing the power of the study. Interestingly, considering examination during a median follow-up of 11 years. the high percentage of contamination in the control Specifically, 10 years after the randomization, the group of the PCLO, this trial could be considered Authors observed 92 prostate cancer-related deaths as a comparison between a population-based and in the screened patients, compared to 82 in the con- opportunistic screening. Moreover, the significant trol group (RR 1.11 - 95% CI 0.83-1.50). Although number of patients who underwent PSA and/or DRE the follow-up of the PCLO trial is planned to continue test within past 3 years before the inclusion in the until 13 years from randomization for all the patients, study might have selected a population of patients the persistence lack of a significant difference in the with lower risk of prostate cancer. death rates between the two randomized groups Considering the ERSPC trial, the conclusions of supported the need to publish these preliminary the study were based on a core of patients aged results 6. between 55-69 years, screened every 4 years with The match seems to be finished in favor of the op- PSA who received indication for a sextant prostate ponents of the PSA screening. However, in the sub- biopsy for value of PSA > 3 ng/ml. In this study, the sequent article of the same issue of the New Eng- compliance to the screening protocol resulted 82% land Journal of Medicine, Schroder et al, reported as planned, while the authors did not report any the results of the third pre-planned interim analysis information on contamination in the control group, of the ERSPC trial. Specifically, the authors found initially estimated to be as low as 20%. Similarly, no that PSA screening without digital rectal examina- information were available concerning the number of tion was associated with a 20% relative risk reduc- PSA test performed before