In a new study, researchers found that the benefits of the prostate-specific antigen (PSA) test to screen men for prostate cancer may be greater than the harm.
They concluded that the advantages of widespread screening, including reduced mortality and the potential to avoid metastases, are likely greater than estimates cited in current guidelines.
The research was conducted by a team from Seattle Cancer Care Alliance and elsewhere.
Routine screening relies on blood-level measurements of PSA, produced by the prostate gland.
Men with prostate cancer often have elevated PSA levels.
Screening is a balance of considerations: the potential to prevent someone from dying of prostate cancer versus drawbacks such as over-diagnosis and over-treatment of prostate cancer.
Over-diagnosis is the discovery of cancer that would not have been detected otherwise in the patient’s remaining years.
Over-treatment, the treatment of over-diagnosed cancer, can cause substantial harms, including urinary incontinence and erectile dysfunction.
Currently, much of the medical community consider PSA testing as an example of a screening tool that is ineffective largely based on short-term data from two trials.
Perceptions of PSA testing as ineffective, combined with overstated harms, have led agencies such as the U.S. Preventive Services Task Force and organizations including the American Academy of Family Physicians to shy away from recommending routine screening for men.
In the study, the team used data from the more reliable of the two trials, and conservative assumptions to create a model and extrapolate the mortality reduction due to screening from 16 years of follow-up to 25 years of follow-up.
The results show that continued accrual of benefit over time creates a much more favorable picture of the value of screening.
The team says the time has come to rethink the use of PSA testing, particularly in high-risk populations, so that doctors do not miss the opportunity to improve the ability to diagnose prostate cancer earlier, enhance the ability to treat it effectively and save more men from serious illness and death.
One author of the study is Dr. Yaw Nyame, a clinical fellow of urology at the University of Washington School of Medicine.
The study is published in the New England Journal of Medicine.
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