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Prostate cancer

PSA update—no change yet

Nature Reviews Urology volume 11, page 483 (2014)Cite this article

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Screening for prostate cancer is a hugely controversial issue. The initial success of PSA in increasing cancer detection is now considered by many to have come at too high a price, both financially and in terms of substantial overdiagnosis of low-grade cancer that has minimal risk of progression over the lifetime of the patient. Overtreatment in these cases risks long-term morbidity, and the blunt tool of PSA screening is no longer recommended for general use in the USA.

The aim of the ERSPC trial was to determine the effect of PSA screening on subsequent mortality. 162,243 men aged 55–69 years were randomly allocated to the intervention and control groups. Prostate biopsy was indicated by serum PSA ≥3.0 ng/ml. With data truncated 13 years after randomization, 7,408 cases of prostate cancer had been identified in the screening group, and 6,107 in the control group, resulting in 355 and 545 deaths, respectively. Median follow-up time from cancer diagnosis was 6.4 years with screening, and 4.3 years without. The number needed to invite (NNI) to prevent one prostate cancer death fell from 1,410 at 9 years to 781 at 13 years, and the NNI to detect one cancer fell from 48 to 27. The rate of prostate-cancer-specific mortality was 21% lower in the screening group than in the control group, an improvement on the 15% reduction reported 9 years after randomization.

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References

  1. Schröder, F. H. et al. Screening and prostate cancer mortality: results of the European Randomised study of Screening for Prostate Cancer (ERSPC) at 13 years of follow-up. Lancet 10.1016/S0140-6736(14)60525-0

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  1. Robert Phillips
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Phillips, R. PSA update—no change yet. Nat Rev Urol 11, 483 (2014). https://doi.org/10.1038/nrurol.2014.210

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