Men who underwent a single PSA testing for prostate cancer screening had mortality rates that closely aligned with those patients who did not get screened at all, according to findings recently published in JAMA.
“Although there is fair-quality evidence that screening by PSA testing reduces prostate cancer deaths, debate continues about the trade-off between the mortality benefit and risks of harm from overdetection and overtreatment,” Richard M. Martin, PhD, of the department of population health sciences at the University of Bristol in England, and colleagues wrote.
Researchers randomly grouped patients recruited between 2001 and 2009 (mean age, 59 years) to either receive a single PSA test or forgo screening. Patients were followed for a median of 10 years.
Martin and colleagues found that after follow-up, 549 of the 189,386 patients in the intervention group (0.30 per 1,000 person-years) died of prostate cancer in this group vs. 647 of the 219,439 patients in the control group (0.31 per 1,000 person-years; rate ratio [RR] = 0.96; 95% CI, 0.85–1.08). A review of all patients’ all-cause mortality showed there were 25,459 deaths among those who received screening, compared with 28,306 deaths among those who did not (RR = 0.99; 95% CI, 0.94–1.03).
Men who underwent a single PSA testing for prostate cancer screening had mortality rates that closely aligned with those patients who did not get screened at all.
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In addition, the number of patients diagnosed with prostate cancer was higher in the intervention group (n = 8,054) vs. those in the control group (n = 7,853; RR = 1.19; 95% CI, 1.14–1.25). Also, of the 64,436 patients in the intervention group who had a positive PSA test result, 6,857 had a PSA level from 3 ng/mL to 19.9 ng/mL and of those, 5,850 underwent biopsy.
“This trial provides new evidence that complements published trials ... [however], extended follow-up of the ... trial is crucial to ascertain whether the evidence of increased detection from the screening intervention coupled with treatment-related effects on the occurrence of metastases translate into longer-term survival benefits,” Martin and colleagues wrote.
Such longer-term follow-up is in process, but the current findings “do not support” single PSA testing for population-based screening, researchers added.
In a related editorial, Michael J. Barry MD, of the division of general medicine at Massachusetts General Hospital, wrote that there are many “remarkable strengths” to Martin and colleagues’ trial, and agreed that their findings “do not provide compelling support for PSA screening.”
He offered some suggestions to the prostate cancer screening process that could provide better emotional, medical and financial benefits.
“Efforts to uncouple the risk of overtreatment from the higher risk of diagnosis may help mitigate the harms of PSA screening for men who decide to be screened. Active surveillance programs appear to be helpful, yet the concern about allowing even a few prostate cancers to escape from possible cure during surveillance may be leading to more and more intensive surveillance, including frequent biopsies and now, magnetic resonance imaging scans. How ‘active’ active surveillance needs to be and which men are candidates requires further research,” he wrote.
“More selective treatment, including avoiding overtreatment of men with low-risk cancer cases but also avoiding undertreatment of men with high-risk cancer cases, combined with offering screening to men aged 55 to 69 years ... even has the potential to make PSA screening cost-effective,” Barry added. – by Janel Miller
Barry reports receiving a salary as chief science officer for Healthwise and receiving grants from that organization that were awarded to Massachusetts General Hospital. He is also a member of the U.S. Preventive Services Task Force, but says his views are not necessarily those of the USPSTF. No other relevant financial disclosures were reported.