Controversy abounds regarding the question of whether routine prostate-specific antigen (PSA) testing reduces mortality from prostate cancer. That controversy became more intense after a recent analysis of benefits and harms of PSA screening, conducted by the US Preventive Services Task Force, recommended against routine PSA screening in asymptomatic men. However, according to results from 2 additional years of follow-up in the European Randomized Study of Screening for Prostate Cancer, PSA-based screening significantly reduces men’s long-term risk of death from prostate cancer, but not all-cause mortality (Schröder FH, et al. N Engl J Med. 2012;366:981-990).
The study involved 182,160 men (age, 50-74 years) in 8 European countries. The men were randomly assigned to the PSA-based screening group (N = 72,891) or to the control group of no screening (N = 89,352). The primary end point was mortality from prostate cancer. A total of 136,689 tests were performed, with a rate of 16.6% positive tests.
At a median follow-up of 11 years, the 162,388 men in the core age-group (55-69 years) showed a rate ratio of 0.79 (95% confidence interval, 0.68-0.91; P = .001), corresponding to a 21% relative mortality risk reduction, favoring the PSA screening (the death rate was 29% after adjusting for noncompliance). Overall, there were 9.66 prostate cancer cases per 1000 personyears in the PSA screening group versus 5.95 cases per 1000 person-years in the non-screening group.
The absolute reduction in mortality risk with PSA screening was 1.07 per 1000 men at a median follow-up of 11 years. To prevent 1 death from prostate cancer in 11 years of follow-up, 1055 men would need to be screened, and 37 cancers would need to be detected. Nevertheless, despite the reduction in the mortality rate from prostate cancer, PSA screening had no effect on all-cause mortality in these men. The investigators suggest that more information on the balance of benefits and adverse effects, as well as the cost-effectiveness of screening for prostate cancer, is needed before general recommendations can be made.
