Can Repeated PSA Screening Reduce Prostate Cancer Mortality?
Posted: Monday, July 22, 2019
An article published in European Urology showed that repeated screening for prostate cancer via prostate-specific antigen (PSA) levels reduced prostate cancer–specific mortality, with a larger absolute benefit with longer follow-up. This conclusion, made by Jonas Hugosson, MD, of the University of Göteborg, Sweden, and his team, is based on data from the 16-year follow-up of the European Randomized Study of Screening for Prostate Cancer.
“The excess [prostate cancer] incidence among screened men is decreasing but is still rather high. The [prostate cancer] mortality reduction seems to be related to the duration of screening, and a one-time screening test is suggested to have little or no effect on [prostate cancer] mortality,” concluded the authors.
The multicenter randomized screening trial was conducted across 8 European countries, totaling 182,260 men followed to 2014. Men randomly assigned to the screening arm were screened an average of 1.94 times, with 28% of these men having at least one positive screening test. The prostate cancer–specific incidence was 13.3% in the screening arm and 10.3% in the control arm.
During the 16-year period of the study, the rate ratio of prostate cancer mortality was 0.80. Absolute prostate cancer mortality at 13 years was 0.14%, increasing to 0.18% at the 16-year mark. A total of 570 men needed to be invited for screening to prevent one death from prostate cancer at the most recent time point, compared with 742 invited men at 13 years. The number needed to diagnose was 26 at 13 years, decreasing to 18 at 16 years. For researchers to detect 5,000 prostate cancers, over 20,000 biopsies were performed, creating a positive predictive value of 24%. Men who had cancer detected in the first round of screening had a higher prevalence of a PSA level higher than 20 ng/mL (9.9%) than those who were diagnosed in the second round of screening (4.1%) as well as a higher prostate cancer–specific mortality rate (hazard ratio = 1.86).
Disclosure: The study authors’ disclosure information may be found at europeanurology.com.