BMJ has published two studies suggesting that less routine use of prostate-specific antigen (PSA) testing for cancer screening may be beneficial.
One study — a meta-analysis of six randomized controlled trials comprising almost 400,000 participants — finds no mortality benefit from PSA testing, with or without digital rectal exam.
The other study, using blood samples from nearly 1200 Swedish men at age 60 in 1981, finds that PSA levels at age 60 correlate very closely with the risk for metastatic cancer or death from prostate cancer by age 85. In fact, levels under 1 ng/mL were associated with a low likelihood of suffering prostate cancer metastases (0.5%).
An editorialist says that "elderly men and those with low risk of disease could be tested less often, if at all."
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The American Urological Association has recommended that baseline prostate-specific antigen testing (and digital rectal exam) be offered to men as young as age 40 — with life expectancies of 10 years or more — after a discussion of testing's benefits and risks.
ReplyDeleteThe recommendation appears in the group's updated "Best Practice Statement" on PSA testing and contrasts with guidelines issued by other groups, including the U.S. Preventive Services Task Force. In August 2008, the USPSTF concluded that "the current evidence is insufficient to assess the balance of benefits and harms of prostate cancer screening in men younger than age 75"; the group also recommended against screening those aged 75 or older.
Two ongoing prostate cancer studies, together comprising a quarter-million men, report discrepant results on the benefits of screening in the New England Journal of Medicine.
ReplyDeleteA U.S.-centered trial found a higher incidence of prostate cancer among those randomized to annual screening (with either PSA or digital rectal exam) than those randomized to usual care (which could include screening). During the trial's 7-year follow-up, however, prostate-cancer death rates were roughly the same between groups.
On the other hand, European investigators report that men randomized to screening, although suffering a higher incidence of prostate cancer than controls, showed a significantly lower rate of prostate cancer death.
An editorialist finds that screening offers "at best a modest effect" on mortality. He concludes that "a shared decision-making approach to PSA screening, as recommended by most guidelines, seems more appropriate than ever."
And in Journal Watch General Medicine, Allan Brett offers this: "Healthcare policy makers also need to ask boldly whether the PSA screening juggernaut — with all the time, energy, and resources consumed by screening and its sequelae — is appropriate in an era of unsustainable growth in healthcare spending."