Screening for prostate cancer confers no significant protection against death from the disease, according to a BMJ study.
Researchers randomized every sixth man in a Swedish city between the ages of 50 and 70 to screening every 3 years; the others underwent no screening. The study, begun in 1987, used digital rectal exam in the first two screenings, and then in 1993, screening for prostate-specific antigen was added. Suggestive results led to fine-needle aspiration biopsy. Outcomes were followed by using national registries of cancer and mortality.
The rate of prostate cancer diagnosis was higher in the screening group than among controls (5.7% vs. 3.9%). Localized tumors were more than twice as frequent in the screened group, but the rate of non-localized tumors was similar between groups. Over 20 years, the prostate cancer–specific death risk ratio between groups was not significant.
Subscribe to:
Post Comments (Atom)
No Mortality Benefit from Routine PSA Screening, Longer-Term Follow-Up Shows
ReplyDeleteScreening with prostate-specific antigen (PSA) testing does not lower the risk for death from prostate cancer, according to a 13-year follow-up report from the PLCO trial, published in the Journal of the National Cancer Institute. This finding extends the trial's 10-year results, which similarly showed no mortality benefit.
In the PLCO trial, some 77,000 men aged 55 to 74 were randomized either to 6 years of PSA testing plus 4 years of digital rectal examinations, or to usual care (which could include opportunistic screening). At 13 years' follow-up, there was no difference between the groups in prostate cancer mortality. The incidence of prostate cancer, however, was significantly higher with screening than with usual care (108.4 vs. 97.1 per 10,000 person-years).
The researchers conclude: "There is no evidence of a benefit [from screening]. Indeed, there is evidence of harms, in part associated with the false-positive tests, but also with the overdiagnosis inseparable from PSA screening."