What is the efficacy of prostate cancer screening?

Updated: Jan 15, 2019
  • Author: Lanna Cheuck, DO; Chief Editor: Edward David Kim, MD, FACS  more...
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Answer

Answer

Data from a Canadian study showed that from 1989-1996, the mortality rate was lower in a PSA-screened cohort than in a control group. Research from Tyrol, Austria, also indicated that screening can aid in reducing disease-specific mortality.

These beneficial effects are likely due to the fact that treatment, rather than observation, may enhance disease-specific survival. This was indicated in a Scandinavian study, which reported that radical prostatectomy was associated with significantly reduced disease-specific mortality, compared with watchful waiting. (No difference in overall survival was noted.) [12]

However, a US study, the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial, compared patients who received annual screening (the study offered PSA tests for 6 years and DREs for 4 years) with patients who did not undergo yearly testing and found no screening-related improvement in mortality. [13] Conversely, the European Randomized Study of Screening for Prostate Cancer (ERSPC) did show a decreased mortality in the trial's PSA-screened group; however, this multicenter study was flawed. [14]

Similar to the American study, a randomized trial comparing Swedish men allocated to screening every third year with those who received no screening showed no difference in prostate cancer–specific survival. [15] The issue remains unresolved.

US data have shown a decrease of 1% per year since 1990 in the prostate-cancer mortality rate, which coincides with the advent of PSA screening. Other theories have been proposed to account for the decrease; these include changing treatment practices and artifacts in mortality rates secondary to the changing incidence of prostate cancer.


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