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July 21, 2020
PSA screening for prostate cancer more beneficial than previously recognized

Damon Runyon Physician-Scientist
Jonathan E. Shoag, MD

Though prostate-specific antigen (PSA) screening has been used for 30 years to detect prostate cancer, conservative recommendations have meant that many men have chosen not to be screened. A new publication from Damon Runyon Physician-Scientist Jonathan E. Shoag, MD, and colleagues at Weil Cornell Medicine shows that PSA screening has benefits beyond lowering prostate cancer death risk, such as prevention of metastatic disease and the impaired quality of life associated with its treatment. The researchers suggest that the balance of benefits and harms of screening may be more favorable than previously recognized.

The researchers used data from the European Randomized Study of Screening for Prostate Cancer which followed men ages 55 to 69 with screening periodically for 16 years.  In the new study, they created a model to extrapolate the reduction in mortality due to PSA screening from 16 years to 25 years of follow-up. With longer follow-up, the survival benefits of screening became more apparent. “We hope organizations reconsider the value of the PSA test in light of our estimates and revise their recommendations,” said Dr. Shoag.

One reason the researchers conducted this study is the recent disturbing trend of prostate cancer metastasizing to other organs by the time it is diagnosed. The authors say that a plausible explanation is a decline in screening following the release of 2012 guidelines from the US Preventive Services Task Force that discouraged screening.

The initial conservative approach to screening was based on concern that overdiagnosis would lead to invasive biopsies with side effects such as incontinence and erectile dysfunction even though a patient's prostate cancer may never progress to advanced or fatal disease. However, men diagnosed with low-risk prostate cancer today choose active surveillance, which involves regular monitoring with the intent of starting treatment if the cancer progresses, rather than opting for treatment right away. Another trend is the use of prebiopsy magnetic resonance imaging scans of patients with an elevated PSA to identify suspicious lesions. If none are found, patients need not undergo biopsy.

Together with these advances and a better understanding of the benefits of PSA testing will help more men receive the right treatment at the right time and reduce the incidence metastatic prostate cancer.

Read more: Cancer Health

Publishished in The New England Journal of Medicine