Prostate Cancer Mortality Reduction: A Double-Edged Sword
A groundbreaking European study has revealed a significant long-term reduction in prostate cancer deaths through prostate-specific antigen (PSA) screening. However, this discovery raises concerns about overdiagnosis, where slow-growing cancers are detected, potentially causing unnecessary treatment and side effects. The research advocates for risk-based screening to address this issue.
The European Randomized Study of Screening for Prostate Cancer (ERSPC) sheds light on the long-term effects of PSA screening. Published in the New England Journal of Medicine, it found a 13% relative reduction in prostate cancer mortality 23 years after screening began. Professor Anssi Auvinen, an epidemiologist at Tampere University, emphasizes the substantial impact of PSA screening on reducing prostate cancer deaths. However, he also notes that the effect diminishes once screening stops, disappearing within nine years.
The study's findings are impressive: for every 456 men invited for screening, one prostate cancer death was prevented, and for every 12 men diagnosed, one life was saved. Interestingly, the absolute benefit of PSA screening grew over time. After 16 years, one death was prevented for every 628 men, but by the study's end at 23 years, this number dropped to 456.
The main challenge with PSA screening is overdiagnosis. Some prostate cancers are so slow-growing that they never become symptomatic, and treating them can be harmful. Risk-based screening is proposed as a solution, focusing on cancers that require treatment. While PSA testing led to more low-risk cancer diagnoses, it also resulted in fewer advanced cases.
Magnetic resonance imaging (MRI) has shown promise in reducing overdiagnosis, enabling the identification of high-risk men for clinically significant prostate cancer. The ERSPC study involved over 160,000 men from eight European countries, with a significant Finnish participation. The study's findings have sparked debates about the introduction of PSA screening in Finland, where prostate cancer is the most common male cancer and the second-leading cause of cancer death.
The research highlights the delicate balance between PSA screening's benefits and potential drawbacks. While it can save lives, overdiagnosis and unnecessary treatment may cause harm. The development of risk-based screening approaches, such as MRI, is crucial to ensure that screening efforts are both effective and patient-friendly.
