Over-Diagnosis Risk From Prostate Cancer Screening
Mortality rate is low with or without screening
WEDNESDAY, March 18 (HealthDay News) -- Screening for prostate cancer does not reduce the mortality rate after seven to 10 years' follow-up, according to study results released online March 18 in advance of publication in the March 26 issue of the New England Journal of Medicine, while a second study in the same issue concludes that prostate-specific antigen-based screening does reduce mortality but runs the risk of over-diagnosis.
Gerald L. Andriole, M.D., of Washington University School of Medicine in St. Louis, and colleagues conducted a study of 76,693 men, of whom 38,343 were randomized to annual screening using prostate-specific antigen (PSA) testing for six years and digital rectal examination for four years, while 38,350 received usual care, which sometimes included screening. The investigators found that the incidence of death and the incidence of prostate cancer were similar in the two groups and that incidence of prostate-cancer mortality was low.
Fritz H. Schröder, M.D., of Erasmus Medical Center in Rotterdam, the Netherlands, and colleagues analyzed data on 182,000 men aged 50 to 74 in seven European countries who were randomized to PSA screening an average of every four years or to a control group, and they found that screening reduced the risk of death from prostate cancer by 20 percent but also resulted in a high risk of over-diagnosis.
"Although the results of our trial indicate a reduction in prostate-cancer mortality associated with PSA screening, the introduction of population-based screening must take into account population coverage, over-diagnosis, over-treatment, quality of life, cost and cost-effectiveness," the authors of the second study write.
Authors of both studies report financial ties to the pharmaceutical industry, and one author of the second study holds a patent for an assay for free PSA.