11:37am Friday 22 September 2017

Identifying Men for whom PSA Screening Saves Lives

New research from Brigham and Women’s Hospital (BWH) attempts to clarify which men may save their life as a result of the PSA screening test.  These findings are published online in the Journal of Clinical Oncology.

“Previous research about the ability of the PSA screening test to save lives failed to separate men based on their coexisting health conditions, or comorbidities.  In this analysis, we find that the selective use of PSA screening in men who are in good health confers significant benefit by being associated with a 44 percent reduction in the risk for dying from prostate cancer,” said Anthony V. D’Amico, MD, PhD, senior author of the paper and professor and chief of genitourinary radiation oncology at BWH. 

While treatments for prostate cancer, such as radical prostatectomy, radiation therapy and hormone therapy are often curative, the additional number of men who need to be treated (NNT) using PSA screening test to eliminate 1 death has been estimated at 48 over a period of 9 years and 12 over 14 years from the European and Swedish randomized PSA screening studies respectively. This risk for overtreatment has led many organizations to make recommendations against the use of the PSA screening test in the general population.  In this new analysis, researchers find that by selectively screening younger and relatively healthy men using the PSA test, the NNT appears to be reduced to only 5 men at 10 years.

Researchers observed however that this reduction in risk for prostate cancer death was not observed in men with more significant comorbidities providing the basis for a more prudent use of PSA testing in a select group of men that can be identified based on age and co-exisitng medical conditions. In this reanalysis of the PLCO US based prostate cancer screening study this cohort constituted 36% of all study participants.

“With the uncertainty about the possible benefit of PSA testing in the general population and concerns regarding both over diagnosis and overtreatment, we hope that these findings will raise awareness about the potential for benefit that exists when using the PSA screening test for men who are in good health,” D’Amico said.

 

Learn more about the Dana-Farber/Brigham and Women’s Cancer Center.


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