A new study finds that annual population-wide screening for prostate cancer using serum prostate-specific antigen (PSA) testing does not reduce the risk of prostate cancer death, giving further ammunition to those arguing against such screening. The study appears online today in the Journal of the National Cancer Institute (JNCI).
The study involved 76 685 men aged 55 to 74 years who were enrolled at 10 US screening centers between November 1993 and July 2001. The men were randomly assigned to have either an annual PSA test for 6 years or usual care, which sometimes included “opportunistic” screening advised by a participant’s primary care physician.
The researchers found that although screening resulted in more cancers being diagnosed, it failed to reduce death rates from the disease. At 13 years of follow-up, the incidence rate for prostate cancer was 108.4 cases per 10 000 person-years in the PSA testing group and 97.1 per 10 000 in the usual care group. But the death rates from prostate cancer were 3.7 per 10 000 men in the PSA testing group and 3.4 deaths per 10 000 in the usual care group, a nonsignificant difference.
Prostate cancer is the second leading cause of cancer deaths (after lung cancer) in US men. In 2010, an estimated 217 730 men were diagnosed with the disease and 32 050 died from it. Some cancer experts believe that early detection and treatment will reduce the death risk from prostate cancer. But critics of the use of population-wide PSA screening note that because the disease is slow-growing, many men who have prostate cancer will die from other causes, such as heart attacks, and aggressive treatment can leave men incontinent or impotent without providing a reduction in their risk of death from the disease.
Last year the US Preventive Services Task Force (USPSTF) issued a draft recommendation stating that PSA screening results in little or no reduction in prostate cancer mortality and that it is associated with harms related to subsequent evaluation and treatments, some of which may be unnecessary. The current USPSTF recommendation also advises against screening for prostate cancer in men 75 years and older because of the slow-growing nature of prostate cancer.
Gerald Andriole, MD, lead author and principal investigator of the JNCI study, said there is value in PSA screening to reduce mortality from prostate cancer but not on a population-wide basis. “Routine mass screening is not going to translate into a reduction in prostate cancer death rates,” said Andriole, who is also chief urologic surgeon at the Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine in St Louis. “But there may well be subsets of men who are at a higher risk of dying from prostate cancer, such as African Americans and those with a family history of prostate cancer. So let’s focus on these men.”