PSA Screening May Not Decrease Prostate Cancer Deaths

Dan Editor
  • Many news outlets including The New York Times and Washington Post are reporting on the results of two new studies that show PSA testing may be doing little to save lives.  In fact, the evidence suggests that although prostate cancer screening with PSA tests may catch more cases in the early stages, this only leads to invasive, unnecessary treatment that does not markedly reduce the number of prostate cancer deaths.

     

    For many men over the age of 50, a yearly PSA test is almost second nature.  In fact, a recent poll shows that 86% of the users on our site have had their PSA level checked in the past year.

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    The first of the two new studies followed 77,000 men ages 55-74 in the United States over the course of 10 years.   One group of the men underwent yearly PSA blood tests, while the other group did not.  At the end of 10 years, 17% more prostate cancers were diagnosed in the group that received annual testing.  However, catching these additional cases did not lower the overall death rate due to prostate cancer.  In fact, there were actually more deaths in the group receiving testing, suggesting that some of the deaths may be due to over-treatment of the disease.

     

    The second study followed 162,000 men in Europe ages 55-69.  As was the case with the American study, the number of prostate cancers diagnosed was higher for the group of men undergoing yearly screenings.  However, this study indicated that there was a reduction (although small - 20%) in the number of prostate cancer deaths in the group receiving annual screenings. 

     

    What does this all mean?  I've asked Dr. Motola to give us his personal take on the data, but just drawing some initial conclusions, the new studies suggest that PSA Testing is not as effective at lowering the prostate cancer death rate as many have previously thought.  And clearly these studies show that testing may lead to catching and treating many cancers that do not need pro-active treatment, and in the process may decrease men's quality of life.  

     

    However, I might argue that it is not the PSA screening that is really a problem-it is the over-treatment of non-threatening prostate cancers.  Given the choice between not knowing you have prostate cancer, and knowing you have it and over-treating the disease, I believe that a large percentage of men would rather know that they have prostate cancer, and take the risks associated with over-treating it.  Our impulse, when we're informed that we have cancer--even localized slow-growing cancer--is to blast it away as soon as possible.  Yes there may be side effects, but GET THAT CANCER OUT OF MY BODY, NOW.  The new data suggests that this impulse may be counter-productive. 

     

    Catching more cancers means treating more cancers... but not treating more cancers that are potentially dangerous.  It is the responsibility of men and their doctors to take a hard look at whether frequent PSA testing is necessary for them because of risk factors like a family history of the disease.  And perhaps more importantly, when cancer is found, men need to accept that not all prostate cancers are threatening and require immediate treatment.  We may want to eliminate cancers as soon as they are found, but oftentimes this only leads to a lowered quality of life due to surgical complications or other invasive treatments.  Men should remain vigilant about the disease, but should also carefully way the risks associated with screening and over-treatment.

     

Published On: March 19, 2009