A new analysis presented at the European Cancer Conference 2013 adds fuel to the ongoing debate over whether routine prostate cancer screening reduces prostate cancer mortality. Overall, lead author Mathieu Boniol, MD, and colleagues found that the harms outweigh the benefits on a population level—which should further discourage the use of routine PSA testing for prostate cancer in the general population.
High-risk groups, including those with a family history of aggressive disease, however, can benefit from PSA testing.
A recent statement by the United States Preventive Service Task Force (USPSTF) recommending against the routine screening of PSA for men who are symptomatic caused controversy and disagreement among the medical community.
Dr. Boniol explains that in this era of high testing, particularly in countries like France, incidence of prostate cancer is now up 14%—but the risk of dying remains at 2%.
In a virtual population of 1000 individuals aged 55 to 69 years of aged—under the best scenario—Dr. Boniol and his colleagues estimated that for 1 cancer death to be prevented, an additional 154 biopsies would have to be performed, of which 9 would require hospitalization for severe adverse events; another 0.2 deaths would result from biopsy complications. The breakdown would be as follows:
Based on data from a variety of sources, Dr. Boniol and colleagues made two sets of estimates. In a group of 1,000 men aged between 55 and 69 years of age who were not exposed to PSA screening for risk of prostate cancer, there would be
116 biopsies performed
60 cases of prostate cancer identified
119 deaths overall
5.17 deaths would be as a consequence of prostate cancer
Conversely, in a group of 1,000 men aged between 55 and 69 years of age who were exposed to PSA screening for risk of prostate cancer, there would be
270 biopsies performed
96 cases of prostate cancer identified
191 deaths overall
4.1 deaths would be as a consequence of prostate cancer