PSA screening to detect prostate cancer can be beneficial to younger and at-risk men: study

Screening younger men and men at risk of prostate cancer can be beneficial in reducing metastatic cancer and deaths and should not be abandoned, states an article published in CMAJ (Canadian Medical Association Journal).

The United States Preventive Services Task Force, which last issued prostate in 2008, recently issued a draft recommendation against prostate-specific antigen (PSA) screening for men of all ages. However, the and the American Urological Association both recommend that men be given a choice about whether they should be screened. The United Kingdom and Australia take the approach of informed choice to enable patients to make their own decisions. The Canadian Task Force on Preventive Health Care, which recommended against in its last guidelines in 1994, is expected to issue updated recommendations in 2013.

Recent research from a large, high-quality randomized trial of 162 243 men in Europe aged 55 to 69 years indicates that screening reduces deaths caused by . Other trials, such as the US Prostate, Lung, Colorectal and Ovarian Trial, showed no benefit in screening.

"Cancer-specific mortality, not overall mortality, is the primary outcome in screening trials," writes Dr. Monique Roobol, Department of Urology, Erasmus University Medical Centre, Rotterdam, the Netherlands, with coauthors. "Because deaths from prostate cancer are a small proportion of all deaths, comparisons of overall mortality are underpowered. Thus, a screening program that reduces cancer-specific mortality should not be stopped because of a lack of reduction in overall mortality."

Screening can also reduce the incidence of metastatic cancer, as the European Randomized Study of Screening for Prostate Cancer underscores, which found a 41% reduction in metastatic disease at diagnosis of the cancer with screening.

The authors write that the decision to screen or not to screen should be individual as screening is not appropriate for every man. For elderly men with several medical issues, screening may be more harmful than beneficial, but for younger, healthy men, screening can reduce death from prostate cancer. Healthy younger men also are at lower risk of complications from biopsies and treatments compared with older men.

"Rather than abandoning a screening test that reduces death and suffering, efforts should be focused on selecting patients more carefully," conclude the authors. "Screening should be encouraged for healthy younger men and men with risk factors (e.g., black ancestry, positive family history) and discontinued for elderly men with multiple comorbidities and limited life expectancy."

More information: www.cmaj.ca/lookup/doi/10.1503/cmaj.111962

add to favorites email to friend print save as pdf

Related Stories

Recommendation against PSA test goes too far: expert

Oct 12, 2011

(Medical Xpress) -- A draft recommendation by the U.S. Preventive Services Task Force calling for an end to routine PSA testing for healthy men age 50 and older goes too far, says a prostate cancer expert at the Siteman Cancer ...

Screening does not reduce prostate cancer deaths

Apr 01, 2011

Screening does not significantly reduce prostate cancer deaths, but the risk of overdetection and overtreatment is considerable, concludes a 20-year study published in the British Medical Journal today.

Recommended for you

Blood biomarker may detect lung cancer

4 hours ago

A new study shows that patients with stage I to stage III non-small cell lung cancer have different metabolite profiles in their blood than those of patients who are at risk but do not have lung cancer. The study abstract ...

ACG: Recent increase in incidence of young-onset CRC

20 hours ago

(HealthDay)—The incidence of young-onset colorectal cancer (CRC) is increasing, and the disease is more aggressive pathologically. These findings are being presented at the annual meeting of the American ...

User comments