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Prostate Cancer Screening: Do Benefits Outweight Risks?

By AusSMC

Screening for prostate cancer could reduce deaths from the disease by about one-fifth, according to long-term results of a European study involving over 162,000 men. Despite this new evidence for the efficacy of prostate-specific antigen (PSA) testing, the authors question whether the benefits of screening outweigh the harms, and recommend against routine PSA screening programs.

Source: Schröder et al., The Lancet, published online at http://dx.doi.org/10.1016/S0140-6736(14)60525-0

“The results are not surprising given previous reports and updates from the individual participating centres that the study data was collected from over the past 13 years. The key findings indicate that screening can reduce death from prostate cancer, but the risk of over-detection and over-treatment is considered too high to roll out a national screening program.

“In the last 20 years, Australia has seen a huge increase (275%) in the number of men diagnosed with prostate cancer. A recent Cancer Council NSW study found that 75% of men treated for localised prostate cancer suffer severe and persistent impotence, a clear reminder of the consequences of detecting and treating this disease in men who may not have a lethal form of the disease.

“Until further evidence is available and a more stringent screening process determined, Cancer Council NSW recommends that men discuss prostate cancer with their doctors from age 50 (age 40 if they have a family history) and decide whether they wish to be tested based on their own circumstances and how they weigh up their own risks and benefits. This consultation process ought to be an extensive one, with medical professionals advising men of screening and treatment options and their possible outcomes.”

A/Prof David Smith is a cancer epidemiologist at Cancer Council NSW.

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“This is the 13-year follow-up to one of the two big randomised trials of PSA testing that was conducted in Europe. It continues to show a survival advantage among those who receive PSA testing. However, it doesn’t make a case for population screening.

“The authors acknowledge that in order to determine whether there are a group of men who should undergo screening with PSA, we would need to quantify the adverse effects. There are a large proportion of men who are diagnosed with prostate cancer through PSA who ultimately don’t die of the disease. This over-diagnosis leads to individuals having adverse effects associated with treatment, including impotence and incontinence. In this study, for every 27 extra cases of prostate cancers detected through screening, one death was averted.

“The results ultimately show why we need to focus on developing a better test that can better predict which prostate cancers are life-threatening.”

Professor Ian Olver is the CEO of Cancer Council Australia.