Stop giving PSA test to elderly, study urges

Annual screening leads to more cancer diagnoses but not fewer deaths, say researchers who followed more than 76,000 men for up to 13 years.

By Christine S. Moyer — Posted Jan. 20, 2012

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Adding to the debate about when to screen men for prostate cancer is a study that shows testing annually for the disease does not reduce deaths.

The research, published Jan. 6 in the Journal of the National Cancer Institute, updates findings from the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial that began in November 1993.

Authors of the most recent study urge physicians to stop screening for the disease in elderly men and those with a limited life expectancy.

"We need to take a more targeted approach and selectively screen men who are young and healthy, particularly those at high risk for prostate cancer, including African-Americans and those with a family history of the disease," said lead study author Gerald Andriole, MD.

"A large majority of the cancers we found [in the study] are slow-growing tumors that are unlikely to be deadly," said Dr. Andriole, chief urologic surgeon at the Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine in St. Louis.

The study follows the October 2011 release of a draft recommendation by the U.S. Preventive Services Task Force against PSA-based screening for prostate cancer in men without symptoms of the disease. Medical experts say that such screening can expose men to unnecessary harms, including impotence, infection and urinary incontinence.

Prostate cancer is the second-leading cause of cancer death in men after lung cancer, according to the American Cancer Society. The organization estimates that there were more than 240,000 cases of prostate cancer diagnosed in 2011 and that 33,720 men died of the disease.

For the Journal of the National Cancer Institute study, researchers followed more than 76,000 men for up to 13 years who were in the cancer screening trial. They randomly assigned 38,340 participants 55 to 74 years old to an intervention group. The remaining men were in a control group.

Men in the intervention group received an annual prostate-specific antigen test for six years and a yearly digital rectal examination for four years. A positive test was defined as PSA value greater than 4 ng/mL or a suspicious DRE.

Researchers identified 12% more prostate tumors among men screened annually compared with those in the control group who received routine care (link). But deaths due to the disease did not differ significantly between the groups, the study shows.

There were 158 prostate cancer deaths among men in the intervention group compared with 145 in the control group.

"The data confirm that for most men, it is not necessary to be screened annually for prostate cancer," Dr. Andriole said.

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