Proactive Prostate Screening May Stop Cancer Deaths After All

A new study takes a deeper look at prostate cancer screening research, finding that the now disfavored PSA tests may actually be more valuable than previously believed.

Current guidelines issued by the United States Preventive Services Task Force state that prostate-specific antigen, or PSA, screenings for prostate cancer should not be a routine practice.

According to the National Cancer Institute, the test measures the amount of PSA in a patient’s blood. A higher-than-average PSA level suggests a prostate issue. Given that the process appears fairly clear-cut, why doesn’t the USPSTF recommend PSA screenings as a routine test?

One reason is conflicting data regarding the effectiveness of PSA tests. The European Randomized Study of Screening for Prostate Cancer showed favorable results for PSA screening as a means to reduce prostate cancer deaths. However, another major source of data, the U.S. Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial, showed negligible power to prevent prostate cancer deaths.

This doubt — coupled with the fact that treatment for prostate cancer carries sometimes serious health and psychological impacts — has led PSA tests to fall out of favor.

Indeed, since 2008, doctors have cautioned against what was once a routine yearly prostate check.

However, new research, published this month in the “Annals of Internal Medicine” suggests that current recommendations are based on an error: The studies that underpin this recommendation were conducted using different methodologies –  as a result, their findings can’t be compared directly without first accounting for that fact.

Putting PSA screening data in perspective

Researchers from the University of Michigan and the National Cancer Institute used a mathematical model to try to account for the differences in the studies.

After doing so, the scientists argued that most of the differences between the ERSCPC study and the PLCO study actually disappear, largely due to varying definitions of ”screening” and “unscreened.”

In Europe, unscreened referred to men who weren’t receiving any PSA screenings. But in the U.S., because the practice of screening was so commonplace, unscreened simply meant men who hadn’t been screened recently.

Furthermore, the U.S. study tested men every year, while the European trial tested men every two to four years. Again, this difference in frequency introduces uncontrolled variables in the data.

Once the researchers accounted for these facts, they tried to find comparative areas between the studies. The researchers concluded that PSA screening, when carefully managed, could be a useful proactive measure against prostate cancer deaths and should be reconsidered by the United States Preventive Services Task Force for wider recommendation.

The trouble with prostate cancer screening

Prostate cancer screening has always been a tricky prospect — namely because prostate cancer often progresses comparatively slowly. This type of cancer occurs in men who are usually over the age of 50 – and, many, over 60 — so there are other considerations to be made.

For one thing, prostate cancer can take so long to progress, that a patient could die of another completely separate health complaint many years after the initial diagnosis. In fact, many men with prostate cancer have lived largely untroubled by any symptoms.

In addition, PSA testing resulted in many men seeking biopsies. While these procedures are usually safe, they can carry risks like infection — and even lead to radiation treatment and surgeries. Post-op complications like infections, as well as conditions like loss of bladder control and sexual function may also occur.

As such, some doctors have argued the actual interventions may be worse for the patient than monitoring a slow-growing tumor and taking steps only when it shows signs of being an overt threat.

It is here that we find the crux of the issue: When considering any medical procedure, doctors must make careful decisions about the benefit versus cost to patients. In this case, many health professionals believed that PSA screening gave marginal results, at best, in terms of saving lives — and was actually costing patients more in terms of other health risks.

The researchers in this latest study do not dispute that recommendations for PSA testing should to look at these factors carefully – they simply advocate for a more proper review of PSA testing data.

In the meantime, researchers are currently trying to finesse PSA testing to make it more accurate. Scientists hope to eliminate  over-diagnosis through false-positives and determine the best age ranges for optimal routine testing.

In short, PSA screening needs a lot of work, but it may still help us save lives.

Photo Credit: Gus Moretta/Unsplash

29 comments

Cruel Justice
Cruel J9 days ago

Noted.

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One Heart i
One Heart inc13 days ago

Thanks!!!

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ellie d
Ellie M14 days ago

ty

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Daniel N
Daniel N15 days ago

thanks for posting

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One Heart inc
One Heart inc16 days ago

Thanks!!!

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heather g
heather g16 days ago

Thanks

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Ruth S
Ruth S17 days ago

Thanks.

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Ruth Rakotomanga
Ruth Rakotomanga17 days ago

It seems that PSA readings go up and down, so they're not reliable to make a diagnosis but just one of a number of factors to consider.

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Carole R
Carole R17 days ago

Good news.

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Aaron F
Aaron F18 days ago

Isn't it funny how general conclusions are generally based on a single study? What about the vast numbers of previous studies?

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