A CAP randomized case-control study, published in the Journal of the American Medical Association, evaluated the effectiveness of prostate cancer screening using prostate-specific antigen (PSA) testing. The results of this large-scale study indicated that the use of the PSA test in prostate cancer screening has a modest impact on the mortality ratebeing associated with the risk of overdiagnosis and the appearance of false negative results.
Data analysis revealed that approx one in six prostate cancer cases detected by a single PSA screening was overdiagnosed, leading to unnecessary treatments. Although men who participated in PSA screening had a slight reduction in mortality compared to those who did not have PSA screening, the absolute benefit of screening was considered modest in the context of overall mortality.
The study involved more than 400,000 men aged 50 to 69 who were followed for an average of 15 years. Although the difference in mortality rates between the test and control groups was reduced, it was not considered statistically significant.
Professor Richard Martin, lead author of the study, stressed the importance of finding more accurate methods of identifying aggressive prostate cancer, to enable appropriate treatment to be initiated in the early stages of the disease. Moreover, overdiagnosis of prostate cancer can have significant consequences on the psychological state of patients, and treatment can be associated with various physical adverse effects, such as the possibility of infection after biopsy, erectile dysfunction, bladder and bowel damage. If a man has urinary symptoms, most of them are caused by prostatic hyperplasia, not cancer. Despite the fact that the PSA value is used to decide whether to continue testing in men with urinary symptoms, researchers have shown that it may have low accuracy in differentiating between a high-risk malignancy and a low-risk one that does not require aggressive treatment.
“Our studies measured the effectiveness of the PSA test in thousands of men for 15 years. The main conclusion is that the small reduction in prostate cancer deaths by using the test to screen healthy men does not outweigh the disadvantages. This leads to invasive treatment being given to men who do not need it, many years earlier than without screening. The test also fails to differentiate between cancers that require treatment. We need to find better ways to identify aggressive prostate cancer so that it can be treated early,” said Professor Richard Martin in an article published in Medical Xpress.
Although the PSA test remains a useful tool in the diagnosis of prostate cancer, UK screening authorities does not recommend its routine use due to uncertainty regarding the benefit-risk ratio. Research is currently ongoing to identify new diagnostic and treatment modalities, including the use of magnetic resonance imaging (MRI) and the development of genetic and urine tests for more accurate detection of aggressive prostate cancers.
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Tags: STUDY PSA screening impact prostate cancer mortality rates
