Prostate cancer: A battle fought with screening, but at what cost? A recent European study reveals a significant win in the fight against prostate cancer: long-term reduction in mortality thanks to prostate-specific antigen (PSA) screening. But here's where it gets controversial: the very method saving lives also leads to overdiagnosis.
This research, published in the New England Journal of Medicine, stems from the European Randomized Study of Screening for Prostate Cancer (ERSPC), offering a fresh perspective on the long-term impact of PSA screening. The study's findings are compelling: PSA screening results in a 13% relative reduction in prostate cancer mortality 23 years after the screening began.
Professor Anssi Auvinen of Tampere University, a key investigator in the study, highlights the positive impact, stating, "Long-term follow-up demonstrates that PSA screening can substantially reduce deaths from prostate cancer." However, he also points out a critical caveat: the benefits wane after screening stops, largely disappearing within nine years.
The study's numbers paint a picture of both promise and caution. Screening helped prevent one death from prostate cancer for every 456 men invited for screening and for every 12 men diagnosed with the disease. The benefit of screening increased over time: at the end of the 23-year study, only 456 men needed to be invited to prevent one death.
And this is the part most people miss: The downside of PSA screening is the detection of slow-growing, harmless cancers. Overdiagnosis can lead to unnecessary treatments, which can cause more harm than good. These slow-growing cancers may never pose a threat, yet their treatment can diminish a patient's quality of life due to side effects.
The study found that elevated PSA levels were found in 16% of the participants, but only 24% of those men were confirmed to have prostate cancer via subsequent biopsies. This highlights the potential for a considerable number of unnecessary tests and procedures.
But is there a better way?
Risk-based screening, which identifies men at higher risk of developing aggressive prostate cancer, is gaining traction. This approach could lead to more effective treatment. The researchers advocate for the development of risk-based screening.
So, what does this mean for you?
The PSA test is an effective predictor of prostate cancer risk and the likelihood of death from the disease. Since the mid-1990s, when the ERSPC study began, risk-based screening methods have improved. For example, magnetic resonance imaging (MRI) can help reduce overdiagnosis.
The ERSPC study involved over 160,000 men from eight European countries, with nearly half from Finland. The study was led by the Erasmus University Medical Center in Rotterdam, the Netherlands.
Currently, Finland lacks a national screening program for prostate cancer, but the use of PSA screening is a hot topic in health care policy debates. Prostate cancer is the most common cancer in men. It is the second-leading cause of cancer death in men in Finland and the third-leading in Europe.
What are your thoughts? Do you believe the benefits of PSA screening outweigh the risks of overdiagnosis? Let's discuss in the comments below!
