One-off PSA screening for prostate cancer does not save lives

March 6, 2018, Cancer Research UK
Micrograph showing prostatic acinar adenocarcinoma (the most common form of prostate cancer) Credit: Wikipedia

Inviting men with no symptoms to a one-off PSA test for prostate cancer does not save lives according to results from the largest ever prostate cancer trial conducted over 10 years by Cancer Research UK-funded scientists and published today (Tuesday) in the Journal of the American Medical Association (JAMA).

Researchers at the Universities of Bristol and Oxford found that testing asymptomatic men with PSA detects some disease that would be unlikely to cause any harm but also misses some aggressive and lethal prostate cancers.

This highlights the flaws of a single PSA test as a way to screen for prostate , and shows the need to find more accurate ways to diagnose cancers that need to be treated.

The CAP Trial, which spanned almost 600 GP practices in the UK and included more than 400,000 men aged 50-69, is the largest trial ever to investigate . The trial compared 189,386 men who were invited to have a one-off PSA test with 219,439 men who were not invited for screening.

After an average of 10 years follow up, there were 8,054 (4.3%) prostate cancers in the screened group and 7,853 (3.6%) cases in the control group. Crucially, both groups had the same percentage of men dying from prostate cancer (0.29%).

There is no national screening programme for prostate cancer in the UK, but men over 50 can ask their GP for a PSA test.

More than 11,000 men die of prostate cancer each year in the UK. While some prostate cancers are aggressive and lethal, others are clinically insignificant and will never lead to any harm or death if left undetected. Ideally, aggressive prostate cancers need to be identified and treated as early as possible. But finding a cancer that would never have caused men harm during their lifetime can have a serious impact on quality of life, including the worry of a cancer diagnosis, the possibility of infection following a biopsy and impotence and incontinence following treatment.

Professor Richard Martin, lead author and Cancer Research UK scientist at the University of Bristol, said: "Our large study has shed light on a highly debated issue. We found that offering a single PSA test to men with no symptoms of prostate cancer does not save lives after an average follow-up of 10 years.

"The results highlight the multitude of issues the PSA test raises - causing unnecessary anxiety and treatment by diagnosing prostate cancer in men who would never have been affected by it and failing to detect dangerous prostate cancers. Cancer Research UK is funding work that will allow us to follow the men for at least a further five years to see whether there is any longer-term benefit on reducing prostate cancer deaths."

Dr Emma Turner, a Cancer Research UK scientist at the University of Bristol and co-author of the study, said: "Prostate cancer is the second most common cause of cancer death in men in the UK. We now need to find better ways of diagnosing aggressive that need to be treated early."

Dr Richard Roope, Cancer Research UK's GP expert, said: "The PSA test is a blunt tool missing the subtleties of the disease and causing men harm.

"This trial illustrates that we need to develop more accurate tools if we want to save men's lives. Cancer Research UK's hunt for finding early stages of aggressive prostate cancer is not over. For example, we're funding research into faulty genes which make some men more likely to develop prostate cancer and studying how these genes could help doctors to identify patients who are more at risk.

"We do not recommend that the PSA should be routinely offered to men without symptoms. However, if a man is particularly worried about his risk of prostate cancer, he should have a full discussion about his risk with his GP."

The UK National Screening Committee does not recommend PSA screening for prostate cancer, but men over the age of 50 without symptoms can ask to be tested as per the Prostate Cancer Risk Management Programme (PCRMP).

Cancer Research UK is calling for Public Health England's PCRMP to be updated to reflect the evidence from the CAP trial.

Each year there are about 47,000 cases of cancer and more than 11,000 deaths in the UK and about 165,000 cases and 29,000 deaths in the US.

Explore further: New prostate cancer risk score could help guide screening decisions

More information: Journal of the American Medical Association (2018). DOI: 10.1001/jama.2018.0154

Related Stories

New prostate cancer risk score could help guide screening decisions

January 10, 2018
A new score for predicting a man's genetic risk of developing aggressive prostate cancer could help guide decisions about who to screen and when, say researchers in The BMJ today.

Dietary isoflavones linked to increased risk of advanced prostate cancer

November 8, 2017
Dietary intake of isoflavones was linked with an elevated risk of advanced prostate cancer in a recent International Journal of Cancer study. No statistically significant associations were observed between the intake of isoflavones ...

What men should know about new prostate cancer screening guidelines

April 17, 2017
Men ages 55 to 69 should talk with their health care provider about prostate-specific antigen (PSA)-based screening for prostate cancer. That's according to new recommendations from the U.S. Preventive Services Task Force.

Prostate cancer tied to higher colorectal cancer risk

March 1, 2016
(HealthDay)—The risk of colorectal cancer is increased after a diagnosis of prostate cancer, according to a study published online Feb. 25 in Cancer.

New findings concerning hereditary prostate cancer

July 11, 2016
It is a well-known fact that men with a family history of prostate cancer run an increased risk of developing the disease. The risk for brothers of men with prostate cancer is doubled. But a doubled risk of what, exactly? ...

Are men with a family history of prostate cancer eligible for active surveillance?

April 6, 2017
Active surveillance—careful monitoring to determine if or when a cancer warrants treatment—is an increasingly prevalent choice for prostate cancer, but it's unclear if the strategy is appropriate for men with a family ...

Recommended for you

Colon cancer is caused by bacteria and cell stress

September 19, 2018
Researchers at Technical University Munich have reported findings related to the development of colon cancer. "We originally wanted to study the role of bacteria in the intestines in the development of intestinal inflammation," ...

Researchers find adult stem cell characteristics in aggressive cancers from different tissues

September 19, 2018
UCLA researchers have discovered genetic similarities between the adult stem cells responsible for maintaining and repairing epithelial tissues—which line all of the organs and cavities inside the body—and the cells that ...

Ketogenic diet reduces body fat in women with ovarian or endometrial cancer

September 19, 2018
Women with ovarian or endometrial cancer who followed the ketogenic diet for 12 weeks lost more body fat and had lower insulin levels compared to those who followed the low-fat diet recommended by the American Cancer Society, ...

Eating foods with low nutritional quality ratings linked to cancer risk in large European cohort

September 18, 2018
The consumption of foods with higher scores on the British Food Standards Agency nutrient profiling system (FSAm-NPS), reflecting a lower nutritional quality, is associated with an increased risk of developing cancer, according ...

Could the zika virus fight the brain cancer that killed john McCain?

September 18, 2018
(HealthDay)—Preliminary research in mice suggests that the Zika virus might be turned from foe into friend—enlisted to curb deadly glioblastoma brain tumors.

CRISPR screen reveals new targets in more than half of all squamous cell carcinomas

September 18, 2018
A little p63 goes a long way in embryonic development—and flaws in p63 can result in birth defects like cleft palette, fused fingers or even missing limbs. But once this early work is done, p63 goes silent, sitting quietly ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.