New data fuel debate over prostate cancer screening

Updated results from a long-term study concludes that regular prostate cancer screening cuts the risk of death from prostate cancer.

But there was no overall difference in death rates between men who got screened and those who didn’t. And the lower chances of dying of prostate cancer came at a high cost.

To prevent just one death, researchers found,1,055 men would need to be offered screening and 37 would be diagnosed with cancer and forced to make tough decision about whether or not to undergo treatment.

What’s more, only two of the eight countries involved in the study saw fewer prostate cancer deaths, while the others six did not.

Screening is done with a simple blood test that measures levels of prostate-specific antigen, or PSA.

The new findings come just months after a large American study found no benefit of screening men at average risk and are unlikely to quell the current controversy over PSA testing.

Three years ago, doctors with the European Randomized Study of Screening for Prostate Cancer (ERSPC) reported that PSA testing, found 1,410 men would need to be screened to prevent one prostate cancer death.

Prostate cancer screening: Should you get a PSA test?
Cancer screening tests — including the prostate-specific antigen (PSA) test to look for signs of prostate cancer — can be a good idea. Prostate cancer screening can help identify cancer early on, when treatment is most effective. And a normal PSA test, combined with a digital rectal exam, can help reassure you that it’s unlikely you have prostate cancer. But getting a PSA test for prostate cancer may not be necessary for some men, especially men 75 and older.

Professional organizations vary in their recommendations about who should - and who shouldn’t - get a PSA screening test. While some have definitive guidelines, others leave the decision up to men and their doctors. Organizations that do recommend PSA screening generally encourage the test in men between the ages of 40 and 75, and in men with an increased risk of prostate cancer.  Ultimately, whether you have a PSA test is something you should decide after discussing it with your doctor, considering your risk factors and weighing your personal preferences.

In the process, 47 men would be diagnosed with cancer, risking side effects from treatment without benefiting.

The new results from the European team extend the follow-up period from the earlier study to 11 years on average for more than 162,000 men ages 55 to 69.

The updated study shows slightly more benefits in terms of cancer deaths than the earlier data.

Pros of PSA screening
- PSA screening may help you detect prostate cancer early.
- Cancer is easier to treat and is more likely to be cured if it’s diagnosed in the early stages of the disease.
- PSA testing can be done with a simple, widely available blood test.
- For some men, knowing is better than not knowing. Having the test can provide you with a certain amount of reassurance — either that you probably don’t have prostate cancer or that you do have it and can now have it treated.
-The number of deaths from prostate cancer has gone down since PSA testing became available.

Dr. Fritz Schroder, who coordinated the study, said he expects future updates to show even bigger differences between screened and unscreened men.

“On the other hand, the main downside is overdiagnosis,” Schroder told Reuters Health by email, referring to the dozens of tumors that would be detected by screening, yet would never have become deadly if left alone.

Men with prostate cancer have different treatment options, ranging from a wait-and-see approach to radiation or surgery. The invasive treatments may have complications and often lead to impotence and incontinence.

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