PSA screening has a minimal impact on prostate cancer-specific mortality but increases the likelihood of other health complications deriving from overdiagnosis, a recent meta-analysis shows.
The study, “Prostate cancer screening with prostate-specific antigen (PSA) test: a systematic review and meta-analysis,” was published in the journal The BMJ.
Measuring prostate-specific antigen (PSA) levels is a common approach for detecting prostate cancer at an early stage, allowing for early treatment and increased chances of survival. However, there are mixed opinions about the reliability of PSA in prostate cancer screening in the healthcare community.
In an attempt to determine the benefits of PSA screening, researchers reviewed the literature for studies that compared PSA screening with usual care. Specifically, they aimed to determine whether PSA tests decreased all-cause mortality and prostate cancer-specific mortality.
Their study included five randomized clinical trials, with a total of 721,718 men ages 40-80.
Data showed that screening increased prostate cancer detection at any stage, with seven more men being diagnosed per 1,000 screened. And fewer men were diagnosed with advanced stage disease, meaning the disease was being caught earlier.
However, PSA screening had no significant impact on the number of people who died of the disease or of any other cause, the researchers noted.
Looking only into studies at lower risk of bias, the team found that screening would lead to one fewer death from prostate cancer in every 1,000 men screened in a 10-year period.
But for every 1,000 screened, investigators estimated that three more would develop urinary incontinence and 25 more would have erectile dysfunction, which have a significant impact on patients’ quality of life.
Also, PSA tests can be unreliable, as some men with low levels of this biomarker may have cancer and fail to have a prompt diagnosis, and some patients with high PSA levels do not have cancer.
“At best, screening for prostate cancer may result in a small absolute benefit in disease-specific mortality over 10 years but does not improve overall mortality,” the authors wrote.
“These benefits need to be weighed against the potential short- and long-term harms of PSA screening, including complications from biopsies and subsequent treatment and the risk of overdiagnosis and overtreatment,” they concluded.