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 Forcestate 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 theprocess appearsfairly clear-cut, why doesn’t the USPSTF recommend PSA screeningsas aroutine test?

One reason is conflicting data regarding the effectiveness of PSA tests. The European Randomized Study of Screening for Prostate Cancershowed 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 ledPSA tests tofall out of favor.

Indeed, since2008, doctors have cautioned against what was once a routine yearly prostate check.

However, new research, published this month in the “Annals of Internal Medicine” suggeststhat current recommendations are based on an error: The studies that underpin this recommendation were conductedusing 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 scientistsargued that most of the differences between the ERSCPC study and the PLCO study actuallydisappear, largely due to varying definitions of”screening” and “unscreened.”

In Europe, unscreened referredto men who weren’t receiving anyPSA 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 thesefacts, theytried to find comparative areas betweenthe 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 canceroccurs 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 cancerhave lived largely untroubled by any symptoms.

In addition, PSA testing resulted in many men seeking biopsies. While these procedures areusually safe, they can carry risks like infection — and even lead toradiation treatment and surgeries. Post-op complications like infections, as well as conditions like loss of bladder controland sexual function may alsooccur.

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 consideringany medical procedure, doctors mustmake careful decisions about the benefit versus cost to patients. In this case, many health professionalsbelieved that PSA screening gavemarginal results, at best, in terms of saving lives — andwas actually costing patients more in terms of other health risks.

The researchers in this latest study do not dispute that recommendations for PSA testing shouldto look at these factors carefully –they simply advocate for a more proper review ofPSA 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-positivesand determine the best age ranges foroptimal 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 J2 months ago

Noted.

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One Heart i
One Heart inc3 months ago

Thanks!!!

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ellie d
Ellie M3 months ago

ty

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Daniel N
Daniel N3 months ago

thanks for posting

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One Heart inc
One Heart inc3 months ago

Thanks!!!

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heather g
heather g3 months ago

Thanks

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Ruth S
Ruth S3 months ago

Thanks.

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Ruth Rakotomanga
Ruth Rakotomanga3 months 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 R3 months ago

Good news.

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Aaron F
Past Member 3 months 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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