Baseline PSA predicts the risk of a future prostate cancer (PCa) diagnosis and death from the malignancy, previous research suggests. Now a new study finds that PSA-stratified screening may reduce the risks of unnecessary tests and overdiagnosis while limiting excess deaths.
Investigators led by Eveline Heijnsdijk, PhD, of Erasmus MC, University Medical Center Rotterdam in the Netherlands, employed 2 models (the Erasmus University Medical Center-MIcrosimulation Screening ANalysis [Erasmus-MISCAN] and the Fred Hutchinson Cancer Research Center [FHCRC]) to evaluate the relative harms and benefits associated with adjusting screening intervals based on baseline PSA.
Compared with traditional biennial screening of men aged 45 to 69 years, lengthening the screening interval from 2 to 8 years for men with PSA less 1.0 ng/mL at age 45 years reduced future tests by 46.8% to 47.0% and overdiagnoses by 0.9% to 2.1%, with 3.1% to 3.8% fewer lives saved, according to results published in the Journal of the National Cancer Institute. Halting screening when PSA remained at less than 1.0 ng/mL at age 60 years or older led to 12.8% to 16.0% fewer tests, 5.0% to 24.0% fewer overdiagnoses, and 5.0% to 13.1% fewer lives saved. The discrepancy between models is partly attributable to differing assumptions about PSA growth and the risk of disease progression.
“PSA-stratified screening strategies investigated in this study substantially reduced the testing burden and modestly reduced overdiagnosis while preserving the majority of lives saved,” Dr Heijnsdijk’s team wrote.
Heijnsdijk EAM, Gulati R, Tsodikov A, et al. Lifetime benefits and harms of PSA-based risk screening for prostate cancer [published online January 9, 2020]. J Natl Cancer Inst. doi: 10.1093/jnci/djaa001