It remains unclear whether the benefits of PSA testing outweigh the harms, but evidence suggests that men with a longer life expectancy may benefit from testing, according to a provisional clinical opinion from the American Society of Clinical Oncology published online in the Journal of Clinical Oncology.
Ethan Basch, MD, of Memorial Sloan-Kettering Cancer Center in New York, and colleagues address the role of PSA testing in the screening of men for prostate cancer (PCa). Evidence was considered from a 2011 Agency for Healthcare Research and Quality systematic review on the benefits and harms of screening, and an updated search was conducted to identify additional related evidence.
The researchers found that, based on one randomized trial, PSA testing resulted in reduced PCa death rates, but it was unclear whether the benefits outweighed the screening-associated harms and unnecessary treatment. Evidence suggested that men with longer life expectancy may benefit from PSA testing. For the majority of men, prostate biopsy-associated adverse events were low, but increasing rates of infectious complications after biopsy were noted in several population-based studies.
“At this point in time, it is uncertain whether the benefits associated with PSA testing for prostate cancer screening are worth the harms associated with screening and subsequent unnecessary treatment,” the authors wrote. “Because the evidence does not clearly inform the issue around PSA-based screening and its downstream effects, the importance of informed and shared decision making becomes paramount.”