PSA Screening Lowers Prostate Cancer Mortality

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PSA-based screening significantly decreases the risk of dying from prostate cancer (PCa), according to updated results of a large European study.

The European Randomized Study of Screening for Prostate Cancer involved 186,160 men aged 50 to 74 years at enrollment, with a predefined core age group of 162,388 men aged 55 to 69 years. Investigators randomly assigned subjects to a screening group or a control group. Men in the screening group were offered PSA-based screening and those in the control arm were not.

After a median follow-up of 11 years in the core age group, those in the screening arm had a 21% decreased risk of PCa death relative to controls, researchers reported in The New England Journal of Medicine (2012;366:981-990). The absolute reduction in mortality in the screening arm was 1.07 deaths per 1,000 men at a median follow-up of 11 years.

Additionally, the researchers calculated that to prevent one death from PCa at 11 years of follow-up, 1,055 men would need to be invited for screening and 37 cancers would need to be detected.

Overall mortality was similar between the two groups (18.2 deaths for 1,000 person-years in the screening arm and 18.5 deaths per 1,000 person-years in the control group).

The investigators stated that the controversy regarding PCa screening has been renewed by the publication of the draft report of the U.S. Preventive Services Task Force, which, after a literature-based analysis of the benefits and harms, recommended against PSA screening of asymptomatic men.

“Clearly, the issue can be resolved only on the basis of evidence that considers both the advantages and disadvantages of screening, data that are not available at this time,” the authors noted.

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