PSA Testing-2
PSA Testing and Mortality
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There continues to be much controversy as to whether prostate cancer screening for all men older than 50 years is a clinically useful—or harmful—tool.
New evidence continues to suggest that annual prostate cancer screening does not reduce deaths from the disease, even among men in their 50s and 60s and those with underlying health conditions, according to data published from the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial.[1] This publication updates a 2009 report of the same men, which also found no mortality benefit from prostate cancer screening.[2] The study comes just months after the October 2011 draft recommendation by the U.S. Preventive Services Task Force calling for an end to routine PSA testing for healthy men aged 50 and older because of concerns that the test does not save lives and often leads to invasive biopsies and aggressive treatments.[3]
The PLCO study involved nearly 77,000 men, aged 55 to 74, who were randomly assigned to receive either annual testing for prostate-specific antigen (PSA) for six years plus digital rectal exams for four years or “routine care”—screening tests only if their physicians recommended them.
The updated results of the PLCO were published online in the Journal of the National Cancer Institute. The data confirmed that most men do not need to be screened annually for prostate cancer, as six years of aggressive, annual screening for prostate cancer led to more diagnoses of tumors but not to fewer deaths from the disease. In addition, a large majority of the cancers found were slow-growing tumors that were unlikely to cause death.
The researchers detected 12% more prostate tumors among men screened annually compared with those who received routine care (n=4,250 tumors, screening arm versus 3,815 tumors, control arm). However, deaths from prostate cancer did not differ significantly between the groups, with 158 deaths from prostate cancer in the screening group and 145 deaths in the routine-care group. Annual screening tests did not reduce deaths among men in their 50s and 60s. Of note is the fact that men diagnosed with prostate cancer and who had a history of heart attacks, strokes, diabetes, cancer, or lung and liver disease were far more likely to die from causes other than prostate cancer.
The Bottom Line?
Because so few men in the study had died from any causes, the researchers believe that it would be premature to make broad generalizations about whether men should continue to be screened. However, they did recommend against prostate cancer screening for men with a life expectancy of 7 to 10 years or less. They also believe that only the youngest men—those with the longest life expectancy—are apt to benefit from screening. They recommend that healthcare providers take a more targeted approach and selectively screen men who are young and healthy and particularly those at high risk for prostate cancer, including African Americans and those with a family history of the disease. And finally, they acknowledge that widespread testing has led to the over diagnosis and overtreatment of many men with slow-growing tumors, with resulting side effects that include incontinence and impotence.
Published January 17, 2012
References
- Andriole GL, Crawford ED, Grubb RL III, et al. Prostate cancer screening in the randomized prostate, lung, colorectal, and ovarian cancer screening trial: mortality results after 13 years of follow-up [published online ahead of print January 6, 2012]. J Natl Cancer Inst. doi: 10.1093/jnci/djr500.
- Andriole GL, Crawford ED, Grubb RL III, et al. Mortality results from a randomized prostate-cancer screening trial. N Engl J Med. 2009;360(13):1310-1319.
- Chou R, Croswell JM, Dana T, et al. Screening for prostate cancer: a review of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med. 2011;155(11):762-771.
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