Single Screening for PSA Levels Does Not Improve Survival in Prostate Cancer
Previous studies have demonstrated mixed results in risk vs benefit of overdetection.
Single prostate-specific antigen (PSA) screenings increased the detection of low-risk prostate cancer but had no appreciable effect on 10-year mortality compared with standard practice without screening, according to a study published in JAMA.
A point of contention in the management of prostate cancer is appropriate screening practices; previous studies have produced mixed results in risk vs benefit of overdetection and overtreatment regarding quality of life and mortality.
For this study, researchers randomly assigned 415,357 men with prostate cancer diagnosed between 2001 and 2009 to an intervention or control group. Patients in the intervention group were invited to a clinic to receive information and undergo PSA testing; patients with a PSA level of at least 3.0 ng/mL were offered biopsy. Patients in the control arm received standard management, and information about PSA testing was provided only upon request.
Of the 189,386 patients assigned to the intervention arm, 40% (75,707) went to the PSA clinic and 36% (67,313) underwent PSA testing; 64,436 patients had a valid PSA test result, of which 11% (6857) had a PSA level between 3.0 and 19.9 ng/mL, and 85% (5,850) underwent prostate biopsy.
After a median follow-up of 10 years, results showed that there were 549 prostate-cancer attributed deaths in the intervention arm vs 647 deaths in the control arm, and a greater number of patients in the intervention arm were found to have prostate cancer compared with the control arm (4.3% vs 3.6%).
There was, however, no significant difference observed in the analysis of all-cause mortality; a total of 25,459 and 28,306 deaths occurred in the intervention group and control group, respectively (P =.49).
The study shows that single PSA screening interventions did not improve prostate cancer mortality after 10 years compared with standard practice, leading the authors to conclude that “although longer-term follow-up is under way, the findings do not support single PSA testing for population-based screening.”
Martin RM, Donovan JL, Turner EL, et al. Effect of a low-intensity PSA-based screening intervention on prostate cancer mortality [published March 6, 2018]. JAMA. doi: 10.1001/jama.2018.0154