Study Finds PSA Testing Cuts Prostate Cancer Death Risk

WEDNESDAY, March 14 (HealthDay News) — Adding another
perspective to one of the most controversial and confounding issues in
medicine, a new European study reports that men who received routine
prostate-specific antigen (PSA) tests to check for signs of prostate
cancer were 30 percent less likely to die from the disease.

But the big picture isn’t simple enough for the new research to solve
once and for all the question of whether PSA testing helps men.

“There is little doubt that a man who undergoes testing will have about
a 30 percent less chance of dying from prostate cancer,” said the study’s
lead author, Dr. Fritz Schroder, professor of urology at Erasmus
University in Rotterdam, Netherlands. “On the other side, there’s a 30
percent chance that a cancer found is insignificant and the patient may be
confronted with the side effects of treatment unnecessarily.”

Schroder is referring to the major issue in the PSA debate: Do the PSA
tests do more harm than good?

In some cases, the tests detect cancer that would be deadly, giving men
an opportunity to treat it and potentially survive. In other cases, men
are unnecessarily treated for cancer that actually would develop so slowly
that it wouldn’t threaten their lives.

There’s also the matter of cost — PSA screenings cost an estimated $3
billion in the United States each year — and the potentially severe side
effects of treatment, including incontinence and impotence. In addition,
the new study found that only about 0.5 percent of men developed the
cancer and died from it in the period reviewed.

For the new study, the scientists examined the medical records of more
than 160,000 men in eight European countries, who ranged in age from 55 to
69 when the study began. Some were randomly assigned to receive PSA
screening tests.

After an average of 11 years, the men in the study who got screened
were 21 percent less likely to have died from prostate cancer.

The study findings appear in the March 15 issue of the New England
Journal of Medicine
.

A physician who wrote an accompanying journal commentary said the new
findings “add more confusion” to the issue. But one thing is clear: They
don’t convince him that routine PSA tests are a good idea.

The problem is that “you can have prostate cancer sitting there, doing
nothing,” said Dr. Anthony Miller, professor emeritus of epidemiology at
the University of Toronto’s Dalla Lana School of Public Health. “It’s not
going to kill them; it’s not going to grow.”

But a PSA test can still discover prostate cancer, leading to
unnecessary tests and treatment.

“You’ll always find people who are convinced that no matter what is
done, the evidence doesn’t matter and what they really want to find out is
if they have any cancer,” Miller said. “They will assume that the mere
fact of finding a cancer will mean that good has been done.”

Miller recommends the PSA test only for men who have certain symptoms
or if it’s used to monitor treatment in men who have prostate cancer. “As
a general screening for healthy men, I do not recommend it at all,” he
said.

Miller also doesn’t recommend the prostate examination done by hand
that physicians commonly give to middle-aged and older men, unless
symptoms are present.

More information

For more about prostate cancer, try the U.S. National Library of
Medicine.

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