All you need to read in the other general journalsBMJ 2012; 344 doi: http://dx.doi.org/10.1136/bmj.e2118 (Published 21 March 2012) Cite this as: BMJ 2012;344:e2118
PSA screening reduces mortality from prostate cancer, a little
Researchers launched a major European trial of screening for prostate cancer in 1991. After 12 years of recruiting and an average of nine years of follow-up, men screened with a prostate specific antigen (PSA) test every four years were 21% less likely to die from prostate cancer than unscreened controls. They were still 21% less likely to die of prostate cancer in an update adding a further two years of follow-up (rate ratio 0.79, 95% CI 0.68 to 0.91).⇑ Absolute differences looked less impressive. Screening reduced prostate cancer deaths from 0.5 per 1000 person years to 0.39 per 1000 person years. Screening programmes would have to invite 936 men and find 33 cancers before a single death from prostate cancer would be prevented. Screening had no effect on all cause mortality.
The authors stop short of making any firm recommendations about screening and suggest we wait for results of quality of life and cost benefit analyses. Men might also appreciate a clearer idea of the risks. About half of all screen detected cancers are thought to be overdiagnosed, say the authors. Screened men face the very real possibility of unnecessary invasive investigations, surgery, or radiation treatments—followed by the equally real possibility of lifelong erectile dysfunction or incontinence.
Borderline benefits coupled with well documented risks have already prompted US government advisers to draft a recommendation against PSA screening for asymptomatic men. A wise move, says a linked editorial (pp 1047-8) The only large screening trial done in the US reported no mortality benefits at all.
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