PSA Screening Significantly Reduces Death from Prostate Cancer

A study of screening for prostate cancer has found that a man who undergoes prostate specific antigen (PSA) testing will have his risk of dying from prostate cancer reduced by 29%.

Participants in the randomized study totaled 182,000, of which 162,000 men contribute to the core age group 55-69. Men randomized to the group being offered screening were tested using the prostate specific antigen (PSA) marker, every two or four years with an average follow-up of 11 years. The cut-off value for deciding if further investigation was needed was set at a PSA level of 3.0 ng/mL or more. Men with this reading were then offered a biopsy.

The long-running European Randomized Study of Screening for Prostate Cancer (ERSPC) is the world’s largest prostate cancer screening study and involves eight countries–Belgium, Finland, France, Italy, Netherlands, Spain, Sweden, and Switzerland.

Prof Fritz Schroeder, the international coordinator of the ERSPC study, explained, “Extending the follow up period strengthens the argument for screening. But it does not decide it. Even so, the risk reduction trend in our study is promising and it is imperative that we continue the follow-up. So far, only about 30% of all men in the study have died. If a larger reduction of prostate cancer mortality is seen by further extending the study beyond the current median of 11 years, we can determine with greater certainty whether the benefit of screening outweighs the disadvantages.”

The main negative aspect of screening is over diagnosis; the diagnosis of cancer that does not pose any threat to the patient because they are slow growing or “indolent.” Separate ERSPC findings already confirm that approximately 30% of detected cancers are unlikely to progress and cause a patient’s death. Even so, the patient has received a diagnosis of cancer and he could face the side effects of “unnecessary” treatment.

Currently, the only way for men with potentially insignificant cancers to avoid what could be unnecessary treatment is to direct them towards an Active Surveillance program. This offers them regular check-ups while delaying, at least temporarily, invasive treatment.

The study appeared on March 15, 2012 in the New England Medical Journal (NEJM).

Related Links:
European Randomized Study of Screening for Prostate Cancer