Yearly Prostate Cancer Screening Does Not Lower Total Number Of Deaths

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Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology
Article Date: 09 Jan 2012 - 0:00 PST

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Mass prostate cancer screenings do not lower total number of deaths from prostate cancer, researchers from Washington University School of Medicine at St. Louis reported in the Journal of the National Cancer Institute. They added that mass routine screenings do not even reduce numbers of deaths among males in their fifties and sixties, as well as patients with underlying health conditions.

The authors cited a US study involving 76,000 males that revealed that after six years of aggressive, yearly prostate cancer screening, there were more tumor diagnoses, but the number of deaths from prostate cancer did not drop.

The latest results of PLCO (Prostate, Lung, Cancer, Colorectal and Ovarian), which were published on January 6th, showed that the majority of men do not need to be screened every year for prostate cancer.

Lead author, Gerald Andriole, MD, wrote:

"The data confirm that for most men, it is not necessary to be screened annually for prostate cancer. A large majority of the cancers we found are slow-growing tumors that are unlikely to be deadly."

In the PLCO study, males aged 55 to 74 were randomly selected to receive routine care or a PSA test once a year for six years plus a digital rectal exam for four years. Routine care means the patient only gets a PSA screening test if the doctor recommends one.

Dr. Andriole explained that this report provides updated data on an earlier report published in NEJM (New England Journal of English), 2009, when the team could not find any mortality benefit from routine prostate cancer screening.

At the time (2009), the researchers said it was too early to make any broad generalizations about PSA screening, because a very small number of males had died of any causes. They had recommended that men whose life expectancy was from seven to ten years should be screened.

Now, Dr. Andriole writes:

"Now, based on our updated results with nearly all men followed for 10 years and more than half for 13 years, we are learning that only the youngest men - those with the longest life expectancy - are apt to benefit from screening. We need to modify our current practices and stop screening elderly men and those with a limited life expectancy.

Instead, we need to take a more targeted approach and selectively screen men who are young and healthy and particularly those at high risk for prostate cancer, including African-Americans and those with a family history of the disease."

Andriole and team believe that adult males should receive a baseline PSA test in their early 40s. According to recent studies, men with elevated PSA levels at that age have a considerably higher risk of eventually developing prostate cancer.

Male patients in their 40s whose PSA levels are low have a very small chance of developing lethal prostate cancer, and do not really need to have further routine testing, Andriole believes.

Below are some data from the latest study:

• 4,250 tumors were detected in the routine PSA screening plus digital rectal examination group
• 3,815 tumors were detected in the routine care group
• There were 158 deaths from prostate cancer in the routine PSA screening group
• There were 145 deaths from prostate cancer in the routine care group

The authors said the difference in deaths from prostate cancer was not significantly different between the two groups.

Routine PSA screening every year of males in their fifties and sixties does not appear to save lives.

The authors found that patients diagnosed with prostate cancer who also had other conditions or illnesses, were far more likely to die from those other illnesses than from the prostate cancer itself. Examples of other illnesses, conditions or events include stroke, diabetes, heart attack, cancer, some respiratory diseases, and liver disease. This suggests that although screenings do detect prostate cancer tumors, most of them are not very harmful.

Andriole agrees that too many men have been over-diagnosed and over-treated for prostate cancer, many of whom subsequently suffered from impotence and incontinence.

Andriole said:

"Mass screening of all men on the basis of age alone is not the way to go, but screening can still be useful in select men. We have to take a more nuanced approach to determine which men should be screened with PSA in the first place, how frequently they should be tested, the PSA level at which they should be biopsied and whether their cancer warrants aggressive therapy."

During the last quarter of last year, the US Preventive Services Task Force called for the end of routine PSA testing for healthy males aged over 50 years, saying that it does not save lives and frequently leads to overtreatment.

The PLCO patients will continue being monitored for a further 15 years, the authors added. The aim being to see what effects cancer screening can have on mortality over the longer term.

In an Abstract in the journal, the authors concluded:

"After 13 years of follow-up, there was no evidence of a mortality benefit for organized annual screening in the PLCO trial compared with opportunistic screening, which forms part of usual care, and there was no apparent interaction with age, baseline comorbidity, or pretrial PSA testing."

Written by Christian Nordqvist
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

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