Study finds PSA testing cuts prostate cancer death risk, but does it save lives?

Countering other reports, researchers found the screen reduced mortality rate by 30 percent.

18 march 2012-- Adding another perspective to one of the most controversial and confounding issues in medicine, a new European study reports that men who received routine prostate-specific antigen (PSA) tests to check for signs of prostate cancer were 30 percent less likely to die from the disease.

But the big picture isn't simple enough for the new research to solve once and for all the question of whether PSA testing helps men.

"There is little doubt that a man who undergoes testing will have about a 30 percent less chance of dying from prostate cancer," said the study's lead author, Dr. Fritz Schroder, professor of urology at Erasmus University in Rotterdam, Netherlands. "On the other side, there's a 30 percent chance that a cancer found is insignificant and the patient may be confronted with the side effects of treatment unnecessarily."

Schroder is referring to the major issue in the PSA debate: Do the PSA tests do more harm than good?

In some cases, the tests detect cancer that would be deadly, giving men an opportunity to treat it and potentially survive. In other cases, men are unnecessarily treated for cancer that actually would develop so slowly that it wouldn't threaten their lives.

There's also the matter of cost -- PSA screenings cost an estimated $3 billion in the United States each year -- and the potentially severe side effects of treatment, including incontinence and impotence. In addition, the new study found that only about 0.5 percent of men developed the cancer and died from it in the period reviewed.

For the new study, the scientists examined the medical records of more than 160,000 men in eight European countries, who ranged in age from 55 to 69 when the study began. Some were randomly assigned to receive PSA screening tests.

After an average of 11 years, the men in the study who got screened were 21 percent less likely to have died from prostate cancer.

The study findings appear in the March 15 issue of the New England Journal of Medicine.

A physician who wrote an accompanying journal commentary said the new findings "add more confusion" to the issue. But one thing is clear: They don't convince him that routine PSA tests are a good idea.

The problem is that "you can have prostate cancer sitting there, doing nothing," said Dr. Anthony Miller, professor emeritus of epidemiology at the University of Toronto's Dalla Lana School of Public Health. "It's not going to kill them; it's not going to grow."

But a PSA test can still discover prostate cancer, leading to unnecessary tests and treatment.

"You'll always find people who are convinced that no matter what is done, the evidence doesn't matter and what they really want to find out is if they have any cancer," Miller said. "They will assume that the mere fact of finding a cancer will mean that good has been done."

Miller recommends the PSA test only for men who have certain symptoms or if it's used to monitor treatment in men who have prostate cancer. "As a general screening for healthy men, I do not recommend it at all," he said.

Miller also doesn't recommend the prostate examination done by hand that physicians commonly give to middle-aged and older men, unless symptoms are present.

More information: For more about prostate cancer, try the U.S. National Library of Medicine.

Study Supports Halt of PSA Testing in Some Older Men

Those 75 to 80 with prostate specific antigen less than 3 ng/mL unlikely to develop high-risk prostate cancer

02 mar 2009-- Men who are 75 to 80 years old and have a prostate specific antigen (PSA) less than 3 ng/mL are not likely to have life-threatening prostate cancer during the remainder of their lives, according to research released online in advance of publication in the April issue of the Journal of Urology.

Edward M. Schaeffer, M.D., Ph.D., of the Johns Hopkins University School of Medicine in Baltimore, and colleagues analyzed data from 122 men with prostate cancer and 727 without the disease in the Baltimore Longitudinal Study of Aging cohort. The primary outcome was death from prostate cancer or development of aggressive prostate cancer.

None of the men between the ages of 75 and 80 who had PSA less than 3 ng/mL died of prostate cancer, the researchers report. However, men of all ages who had PSA of 3 ng/mL or greater had a continually increasing chance of death from the disease, the investigators found.

"The optimal approach to prostate cancer screening remains controversial. To date there is limited evidence with which to inform the decision of when to discontinue prostate cancer screening," the authors write. "Our findings suggest that men 75 to 80 years old who have a PSA less than 3 ng/mL are unlikely to be diagnosed with high-risk prostate cancer during life. Therefore, these men may represent an ideal target group for discontinuation of PSA testing, which could dramatically reduce the costs associated with screening, as well as the potential morbidity of additional evaluations and/or treatment in a population unlikely to experience benefit."

Schaeffer disclosed a relationship with Covidien.

Full Text

AUA: PSA Testing Might Not Be Necessary for Older Men

By Charles Bankhead
ORLANDO, 24 may 2008 -- At age 75, men who have PSA levels less than 3 ng/mL can safely discontinue routine prostate cancer screening because they have a low risk of developing aggressive disease, data from a large prospective cohort study suggest.
In fact, the probability of prostate cancer death and high-risk disease declined steadily in those men, Anna E. Kettermann, of Johns Hopkins, reported at the American Urological Association meeting.
In contrast, a PSA level of 3 ng/mL or greater was associated with an increased probability of developing high-risk prostate cancer.
"Men who have a PSA level below 3 ng/mL at age 75 to 80 are unlikely to develop aggressive prostate cancer during their remaining life, and for these men, PSA testing might be safely discontinued," said Kettermann.
The findings came from an analysis of data on 849 participants in the Baltimore Longitudinal Study on Aging. Investigators calculated each man's probability of developing high-risk prostate cancer in five-year increments, beginning at ages 60 to 65, stratified by PSA cutoff points of <1>3 ng/mL.
High-risk prostate cancer was defined as death from prostate cancer, a PSA value greater than 20 ng/mL, or a prostate biopsy Gleason score of 8 or higher at diagnosis.
The study population comprised 727 men who did not have prostate cancer and 122 who did -- 35 had aggressive disease and 87 were alive with cancer or had died of other causes.
The entire cohort had been followed for a median of 10 years, during which time they had a median of four repeat PSA tests.
The median baseline PSA level was 0.76 ng/mL. The median PSA level was 1.2 ng/mL in men who had high-risk prostate cancer, 1.3 ng/mL in those who had lower-risk prostate cancer, and 0.7 ng/mL in those who remained free of prostate cancer.
Overall, 18 patients died of prostate cancer, and 17 others had high-risk disease. All 35 had PSA values that exceeded 3 ng/mL at some point during follow-up.
None of the remaining 87 patients with lower-risk prostate cancer or those who remained free of prostate cancer had PSA levels that exceeded 3 ng/mL during follow-up.
"Our analysis showed that the probability of high-risk prostate cancer increased with PSA value," said Kettermann.
Primary source: Journal of UrologySource reference:Carter HB, et al "Prostate specific antigen testing among the elderly: When to stop?" J Urol 2008; 179(suppl): 600. Abstract 1751.