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Harm from prostate cancer screening may outweigh potential benefits
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Although widespread screening for prostate cancer may prevent one death in every 1,000 men, the additional biopsies and treatment of low-risk prostate cancers would significantly increase the frequency of adverse effects, according to study results presented at the European Cancer Congress.
PSA testing is still common despite a US Preventive Services Task Force recommendation issued in 2012 that discouraged its routine use in healthy men.
“One of the main problems with using PSA testing for prostate cancer screening is overdiagnosis,” Mathieu Boniol, PhD, research director at the International Prevention Research Institute and professor at the Strathclyde Institute for Global Public Health in Lyon, France, said in a press release. “An overdiagnosed prostate cancer patient is labeled as a prostate cancer case, but he will never suffer from the disease, although he will experience the potential side-effects of prostate cancer treatment.”
Boniol and colleagues used data from the European Randomized Study on Screening for Prostate Cancer to calculate the estimated impact of PSA testing in two hypothetical sets of men aged 55 to 69 years.
The first group of 1,000 men represented a population that would not undergo PSA testing. Researchers estimated that 116 of these men would undergo biopsies and 60 would receive a prostate cancer diagnosis. Out of 193 overall deaths, 5.17 would occur from prostate cancer.
The second group of 1,000 men represented a population that would undergo screening. In that group, researchers estimated 270 biopsies would result in 96 prostate cancer diagnoses. They estimated 191 men would die, and 4.1 would die from prostate cancer.
Researchers determined this difference of one death would equate to 154 additional biopsies, leading to nine hospitalizations and .2 deaths.
An additional 35 cases of primarily low-risk prostate cancer would be diagnosed, leading to treatments that would cause 12 instances of impotence, two instances of incontinence and one instance of fecal incontinence, the researchers determined.
“When discussing the use of the PSA test with patients, physicians should make them aware of the limitations of the test and the likelihood of it causing harm,” Boniol said. “We hope that our research findings will help clinicians to make decisions as to when to propose a PSA test, and to help the patient to decide whether or not to accept this recommendation.”
For more information:
Perrin P. Abstract #1481. Presented at: The European Cancer Congress 2013. Sept. 27 – Oct. 2, 2013; Amsterdam.
Disclosure: The researchers report no relevant financial disclosures.Perspective
Back to TopCora Sternberg, MD
PSA screening holds the promise of early diagnosis when cancer is localized to the prostate and treatment is curative. Screening has, however, also led to many false positive results, overdiagnosis of disease and significant morbidity as demonstrated in this French study, particularly in men over 70 years of age.
International recommendations vary on the value of routine PSA screening. The European Association of Urology says that current evidence is insufficient to recommend the adoption of population screening for prostate cancer as a public health policy due to the large overtreatment effect. The American Urological Association suggests that for men aged 55 to 69 years, PSA screening involves weighing the benefits of preventing prostate cancer mortality in one man for every 1,000 men screened over a decade against the known potential harms associated with screening and treatment. Men are urged to talk with their doctors about benefits and harms of testing. Along the lines of this French study, the American Cancer Society also suggests discussion with the physician regarding the benefits and hazards of early detection.
Perspective
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Cornelis van de Velde, MD, PhD
Screening for prostate cancer is controversial and recommendations exist against PSA-based screening. Despite this, it is widely used, especially in France. This national study indicates that it causes more harm than good, especially in men aged 70 years or older who have triple the risk of younger men of dying after the operation. These results should lead to stricter guidelines and registries to evaluate the overtreatment of prostate cancer.
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