PSA Screening for Prostate Cancer: Does It Really Reduce Disease-Specific Mortality?
Posted: Tuesday, October 30, 2018
Still not sure if you should be screening for prostate cancer? The controversy surrounding whether prostate-specific antigen (PSA) testing in men is of real value is well known. Phillip Dahm, MD, of the University of Minnesota, Minneapolis, and his colleagues, who have written a number of clinical articles on the pros and cons of PSA screening, shed more light on this debate, in an article published in The BMJ.
It is common knowledge that screening for prostate cancer remains highly controversial because of limitations in randomized trials, including contamination and underrepresentation of African American men. In addition, the difficulty of shared, informed decision-making between patients and primary care providers about PSA screening may also contribute to practice variations. To make things a bit more confusing, the U.S. Preventive Services Task Force recently updated its recommendation statement, changing it from a grade D (recommendation against PSA-based screening for prostate cancer) to a grade C (advocating for an individualized approach to screening).
Based upon partial data from the British Medical Journal Rapid Recommendations (BMJRR) project, the researchers systematically reviewed new evidence from the BMJRR as well as from their own more current data to address the potential benefits and harms of PSA-based screening. In particular, they focused on 5 randomized controlled trials including 721,718 participants.
Their conclusion: At best, screening for prostate cancer leads to a small reduction in disease-specific mortality over 10 years but does not affect overall mortality. In fact, the investigators found that PSA screening corresponds to 1 fewer death from prostate cancer per 1,000 participants screened.
“Clinicians and patients considering PSA-based screening need to weigh any benefits against the potential short- and long-term harms of screening, including complications from biopsies and subsequent treatment, as well as the risk of overdiagnosis and overtreatment,” the investigators concluded.