PSA test reduces risk of death in prostate cancer

PSA screening for prostate cancer screening reduces the risk of death by 20 percent

08/08/2014

Can by prostate cancer screening using the so-called „PSA testing“ actually life be saved? For a long time, the PSA screening internationally controversial because so far it was considered unclear whether the benefits of this method outweigh the disadvantages. Now, a long-term European study has shown that the test's risk of death can be reduced by more than a fifth, but at the cost of many unnecessary diagnoses and therapies.

Screening has been causing controversial discussions internationally for years
For years, the screening of symptom-free men on prostate cancer per „PSA test“ controversial. This test measures the amount of PSA (Prostate Specific Antigen) present in the blood, a protein that is produced in the prostate and mixed with sperm during ejaculation. While normally only very small amounts of PSA from the prostate glands get into the blood, various circumstances and diseases can lead to an increase in the PSA level. In addition to urinary tract infections and inflammation of the prostate, this also includes prostate cancer - which is why a PSA test can be performed in order to obtain evidence of possible cancer in the event of suspicion.

Early detection and lower mortality vs. Overdiagnoses and over-treatment
But so far, it was considered unproven whether the benefits of the test outweigh possible disadvantages. For on the one hand is the early detection of prostate cancer and thus a lower mortality of men to prostate cancer, which of course means a great advantage. On the other hand, critics also repeatedly point to the disadvantage of overdiagnosis and over-treatment of non-dangerous cancerous tumors, which would never have been problematic for the affected men even without discovery and treatment. But now scientists from the University of Rotterdam have apparently gained new insights through a European long-term study. According to the PSA test for the early detection of prostate cancer life can be saved - although overdiagnosis and over-treatment could not be excluded.

By regular PSA tests more than 20% lower risk of death
For the „European Randomized Study of Screening for Prostate Cancer“ (ERSPC), which was launched in 1993 in eight European countries, researchers had initially distributed more than 162,000 men aged 50 to 74 years by lot to two groups. In one group, PSA screening was then performed every four years as a diagnostic test for cancer screening, but not in the other group. The result: After nine years, the first group had a 15 percent lower risk of dying than the group that had not been tested. After eleven years, the difference was even more than 20 percent. „The PSA study substantially reduces deaths from prostate cancer, to a similar extent or more than breast cancer screening“, Fritz Schröder from the University Hospital Rotterdam in the trade journal „The Lancet“.

Warning: number of „false“ but still too big
However, even if a PSA screening could reduce the risk of death by more than one-fifth, the scientists said that this was not sufficient reason to introduce the test nationwide as a precautionary measure. For this, the number of „false“ too large, because in about 40 percent of cases diagnosed had been overdiagnoses, which in turn would have led to unnecessary treatments with possible side effects such as incontinence or impotence. According to the researchers, 27 men were treated to save a life within 13 years, so further studies are urgently needed, „to reduce the very large numbers of men undergoing screening, biopsies and therapies to help only a few patients“, explains Fritz Schröder. „In this update, the ERSPC confirms a significant reduction in prostate cancer mortality from testing PSA, with a significantly increased absolute effect at 13 years compared to the 9 and 11 year outcomes. Despite our findings, further quantification of the disadvantages and their reduction are nevertheless regarded as the prerequisite for the introduction of a nationwide screening“, so the conclusion of the researchers. Accordingly, the screening was indeed „not a perfect test“ - Nevertheless, this can help to estimate risks, said Prof. Peter Hammerer of the Association Urological Oncology compared to the „dpa“. Above all, it was important that the men were informed about the advantages and disadvantages in order to be able to assess the validity of the test. (No)