Annual PSA Screening May Benefit Some Men
BOSTON—Annual PSA screening for prostate cancer (PCa) may provide a greater quality-adjusted life expectancy (QALE) among patients who have a high risk of developing metastatic disease compared with unscreened patients, according to a new study presented at the American Society for Radiation Oncology annual meeting.
In addition, the study found that a number of individual factors should be a part of the decision-making process about whether to undergo regular PSA screening.
“Our model suggests, that for certain subgroups of men there may be a quality of life benefit from annual prostate cancer screening and subsequent treatment with radiation therapy,” said lead study author Arie Dosoretz, MD, a radiation oncologist at Yale-New Haven Hospital in New Haven, Conn. “Decision-making about whether men should or should not be screened is complex and nuanced and should be made on an individual basis, with careful consideration of the patient's age, and the potential impact of diagnosis and treatment on their quality of life.”
Dr. Dosoretz and his colleagues compared QALE in men with and without annual PSA screening to provide further guidance on screening and treatment decisions. In comparing screened versus non-screened patients, the study found a slight benefit to screening with a value of 13.70 quality-adjusted life years (QALYs) and 13.24 QALYs, respectively. The benefit of annual PSA screening, however, diminished with increasing age and was dependent on the probability of eventually developing metastatic cancer and the associated decrease in quality of life. For patients who had less than a 4.9% chance of developing PCa within 10 years, the study showed that it would be best to recommend a strategy of no annual screening. The study indicates that factors contributing to whether or not a patient should be screened include the age and health of the patient and the potential impact of screening and a prostate cancer diagnosis on their quality of life.
“What may make sense for one person may not make sense for another person when it comes to screening,” Dr. Dosoretz told Renal & Urology News. “Based on our study, if you are going to maximize quality of life, you need to figure out which men will benefit the most from screening.”
The study, though independent from the European Randomized Study of Screening for Prostate Cancer (ERSPC), used findings from that trial, which randomized approximately 162,000 men. Men aged 65 and older were included in the analyses, and the results from screening were tracked for 25 years.
In men who screened positive for PCa, the study assumed that they had clinically-localized, low-risk PCa, and underwent treatment with intensity-modulated radiation therapy (IMRT). In unscreened men who presented with localized disease, the study also assumed they had low-risk disease and underwent subsequent IMRT. Long-term treatment-related adverse effects included the possibility of developing genitourinary toxicity, gastrointestinal toxicity and sexual dysfunction.
The researchers concluded that there was an improved QALE for men who underwent annual PSA screening compared with those who did not, except for men with a very low risk of developing metastatic disease.