A NEW LONG-term study with a 13 year follow up shows that men who undergo prostate cancer screening reduce the chance of death from the disease by a fifth.
Results from the study, published in The Lancet, showed that screening appeared to reduce prostate cancer deaths by 15% at 9 years and this improved to 22% at 11 years.
The European trial began in 1993, involved 162,000 men, and set out to determine whether screening men for prostate-specific antigen (PSA) reduces deaths from prostate cancer.
Over 13 years follow-up, there was no further improvement in the relative reduction in prostate cancer deaths which decreased by roughly a fifth (21%) in the screening group compared with the control group, although men who were actually screened had a 27% lower chance of dying of prostate cancer.
However, the absolute benefit of screening steadily increased with longer follow-up. The number of men needed to be invited for screening to prevent one death from prostate cancer dropped dramatically from 1410 after 9 years of follow-up to 781 at 13 years.
The number needed to be diagnosed and treated to prevent one prostate cancer death also fell from 48 to 27. The risk of advanced prostate cancer was also smaller in the screening group.
Routine testing
However, despite the findings for the effectiveness of PSA testing, the authors did not recommend that routine screening programmes be introduced at this time.
According to study leader Professor Fritz Schröder from Erasmus University Medical Center in the Netherlands PSA screening delivers a substantial reduction in prostate cancer deaths, “similar or greater than that reported in screening for breast cancer,” he said.
However, he said: “over-diagnosis occurs in roughly 40% of cases detected by screening resulting in a high risk of overtreatment and common side-effects such as incontinence and impotence.”
The time for population-based screening has not arrived. Further research is urgently needed on ways to reduce over-diagnosis preferably by avoiding unnecessary biopsy procedures, and reducing the very large number of men who must be screened, biopsied, and treated to help only a few patients.
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