PSA screening may help reduce prostate cancer associated mortality: JAMA study

A long-term study evaluated the effectiveness of prostate-specific antigen (PSA) screening for prostate cancer and the results highlight the contentious issue in men's health. The crucial findings were published in a recent issue of the Journal of American Medical Association and challenges the previous conclusions while also fueling ongoing debate surrounding the PSA testing.

The study reported the outcomes of a 15-year follow-up period of with extensions from the previous assessments. The primary objective was to assess the impact of a single invitation for PSA screening on prostate cancer-specific mortality when compared to the standard practice with no routine screening. This secondary analysis of the CAP randomized clinical trial involved men of 50 to 69 years old from a total of 573 primary care practices across England and Wales. Over 415,000 eligible men participated in the study with nearly all included in the final analysis.

These results revealed that a single invitation for PSA screening led to a reduction in the prostate cancer deaths when compared to standard practice. At the median 15-year follow-up, there were reduced prostate cancer-related deaths in the group that received the screening invitation. Also, the absolute reduction in deaths was described as small despite being statistically significant. Moreover, the screening intervention was found to increase the detection of low-grade and localized prostate cancer cases. However, it did not significantly impact the diagnosis of intermediate to high-grade tumors or advanced-stage diseases.

Despite these critical findings, the long-term effects of PSA screening on prostate cancer mortality remains a subject of contention. While the study suggests a potential benefit in reducing deaths from prostate cancer, the outcomes emphasize the modest nature of this reduction and raise concerns about over-diagnosis and overtreatment associated with the PSA screening.

The study emphasize the need for continued research to better understand the precise effects of PSA screening and its impact on mortality and the quality of life of the individuals diagnosed with prostate cancer. Overall, the outcomes of this research adds to the complex narrative surrounding PSA screening by illuminating the importance of informed decision-making and personalized approaches to prostate cancer detection and treatment.

Source:

Martin, R. M., Turner, E. L., Young, G. J., Metcalfe, C., Walsh, E. I., Lane, J. A., Sterne, J. A. C., Noble, S., Holding, P., Ben-Shlomo, Y., Williams, N. J., Pashayan, N., Bui, M. N., Albertsen, P. C., Seibert, T. M., Zietman, A. L., Oxley, J., Adolfsson, J., … Mason, M. D. (2024). Prostate-Specific Antigen Screening and 15-Year Prostate Cancer Mortality. In JAMA. American Medical Association (AMA). https://doi.org/10.1001/jama.2024.4011