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Is regular screening for prostate cancer really necessary?

A BMJ commission considered whether or not regular screening for prostate cancer using the prostate-specific antigen test is truly necessary, despite the possible risks it carries.
PSA test sample
Should men opt for routine screening for prostate cancer?

According to an official statement released by the United States Preventive Services Task Force in JAMA, men in the U.S. face an 11 percent lifetime risk of being diagnosed with prostate cancer and a lifetime risk of prostate cancer-related death of 2.5 percent.

Previous studies suggested that one effective way of catching this type of cancer early is screening.

This involves prostate-specific antigen (PSA) testing, which is a blood test that can help establish a diagnosis.

However, PSA testing is not always accurate and might lead to the prescription of unnecessary — and invasive — biopsies, which may harm a person’s quality of life.

False positive PSA results can also result in overdiagnosis and overtreatment, which may affect a person both mentally and physically, thus impacting their overall health.

So, a commission of international experts — both clinicians and research methodologists — and men at high risk of prostate cancer has reviewed and analyzed the results of existing studies weighing up the benefits and risks involved in routine prostate cancer screening.

The results of this complex analysis are now reported in The BMJ.

More harm than good?

The panel analyzed data collected from 721,718 men enrolled in various trials, and it assessed the evidence that emerged from these studies.

Following a detailed analysis, the members of the panel concluded that routine screening for prostate cancer should not be recommended to most men as it may end up doing them more harm than good.

“Based on moderate- and low-quality evidence, PSA screening seems to increase the detection of prostate cancer of any stage, increases the detection of stage 1 and 2 prostate cancer, and slightly decreases the detection of stage 3 and 4 prostate cancer,” write the review’s authors.

“Meanwhile,” they add, “PSA screening is associated with considerable biopsy-related and cancer treatment-related complications.”

We estimated that, for every 1,000 men screened, approximately one, three, and 25 more men will be hospitalised for sepsis, require pads for urinary incontinence, and report erectile dysfunction, respectively.”

At the same time, however, the experts involved in the review note that men who qualify as being at high risk of prostate cancer may still want to consider regular testing after discussing all the possible risks and benefits with their doctors.

Men who are at high risk of prostate cancer, according to guidelines from the Centers for Disease Control and Prevention (CDC), are usually those who have a family history of prostate cancer, as well as those of African descent.

The BMJ panel also says that practicing doctors should not feel like they have to suggest prostate cancer screening to all their male patients, but they should aim to inform those who do wish to undertake PSA testing, assisting them in their decision-making process.

In an editorial written by Prof. Martin Roland and team, from the University of Cambridge in the United Kingdom, other specialists support the conclusions reached by the panel.

The editorial’s authors suggest that, when speaking with patients considering a PSA test, clinicians “should explore their reasons for requesting a test, and include evidence-based discussions about possible harms and benefits of PSA testing, informed by the patient’s ethnicity and family history.”

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