ÈESKÁ UROLOGIE / CZECH UROLOGY – 1 / 2018

15 Ces Urol 2018; 22(1): 14–26 PØEHLEDOVÝ ÈLÁNEK studií nebyla provedena metodologicky správnì a že teprve pøi délce sledování 10–15 let dochází u screenovaných pacientù k významnému snížení mortality na karcinom prostaty, srovnatelnému s ostatními onemocnìními, pro které je bìžnì populaèní screening provádìn. Ve shodì s publikovanými daty není v souèas- né dobì ve vìtšinì zemí otázkou, zda screening karcinomu prostaty provádìt, ale jak ho provádìt. Screening, resp. program èasného záchytu, by mìl v souèasné probíhat selektivnì na základì do- poruèení odborných spoleèností s pøihlédnutím k epidemiologické, zdravotnicko-organizaèní a eko- nomické situaci v dané zemi a individuálnímu zdra- votnímu stavu a pøání informovaného pacienta. Hlavní téze onkologické prevence nedávno jasnì definovala Èeská onkologická spoleènost ÈLS JEP a Ministerstvo zdravotnictví ÈR. Èeská republi- ka splòuje všechny uvedené odborné požadavky na provádìní selektivního screeningu karcinomu prostaty, a to zejména pro urèitou definovanou vìkovou skupinu mužù a pro muže s pøedchozím výskytem nádorového onemocnìní. Na provádìní screeningu tìchto populací nyní panuje shoda mezi odbornými spoleènostmi (Èeská urologická spoleènost a Èeská onkologická spoleènosti ÈLS JEP), Ústavem zdravotnických informací a statistiky ÈR a Ministerstvem zdravotnictví ÈR a dominant- ními plátci péèe v Èeské republice. KLÍÈOVÁ SLOVA Screening, èasný záchyt, karcinom, prostata. SUMMARY Zachoval R, Dušek L, Babjuk M. Problematika screeningu karcinomu prostaty. Major statement: Screening is an attempt to identify individuals with a certain disease in a broad segment of the population – those for whom there is no reason to suspect the disease. Now there is clear evidence that PSA screening reduces mortality if carried out for 10–15 years. The Czech Republic meets all requirements to perform selective prostate screening, particularly for a certain age group of men and for men with a history of other tumour disease with a life expectancy of 10–15 years. Screening is an attempt to identify individuals with a certain disease in a broad segment of the population – those for whom there is no reason to suspect the disease. The screening is performed if there is a high risk of a disease within a population, if a proper diagnostic method exists, and if there is the possibility to treat the disease effectively. The term “early detection” is mainly used for op- portunistic or selective screening. The primary objective of screening is to reduce mortality while keeping the same quality of life as if no disease was diagnosed. Secondary objectives are related to identifying more individuals in less advanced stages of the disease and mapping the incidence of the disease precisely in a respective region. The implementation of Prostate Specific An- tigen examination played a key role for prostate screening. In several countries, a large increase in incidence was seen, as was a decrease in metastatic stage identification. Nevertheless, screening was still controversial, mainly for the uncertain impact on mortality reduction and for the diagnosis and treatment of clinically non significant stages and related adverse screening side-effects. However, it was recently clearly demonstrated that most of the studies were not performed properly. Now there is clear evidence that screening reduces mortality in case of 10–15 years of duration and this mortality reduction is the same as in other diseases for which screening is performed. In accordance with the published literature, it is not a question if prostate screening should be performed, but how it should be performed. Screening, or the early detection program, should be performed selectively based on the recom- mendation of expert organizations regarding the epidemiological, health, structural and economic situation of a respective country, and regarding the individual health condition and wishes of an informed patient. Recently, the main thesis of oncological pre- vention was defined by the Czech Oncological Society and by the Ministry of Health of the Czech Republic. The Czech Republic meets all the above mentioned professional requirements to perform