Test or not to test is the question facing men with regard to prostate cancer

Illustration courtesy of SonaCare

CANCER DIGEST – Sept. 8, 2018 – An international panel of clinical experts recommends against routine testing for prostate cancer. That recommendation followed an extensive review of the available research that they say shows little evidence that such screening reduces prostate cancer deaths. Their findings are published online ahead of the Sept. 5, 2018 British Medical Journal (BMJ).

The panel conducted a meta-analysis of five randomized controlled trials involving 721,718 men who underwent PSA screening at varying intervals and varying thresholds for biopsy, meaning biopsy for cancer was undertaken when PSA levels reached different target levels as determined by the study design.The expert panel concluded that the whole body of evidence showed that such screening had little to no effect on all-causes of death, and may have only a small or no effect on prostate-specific death.

The panel concluded that, at best, screening for prostate cancer leads to a small reduction in disease-specific death over a 10 year period but does not affect overall mortality. While the panel determined that routine screening for most men is not recommended, it did say that men with a family history of prostate cancer should discuss screening with their physicians regarding the possible harms and benefits of testing.

The study confirms the conclusions of the US Preventive Services Task Force (USPSTF), which also recommended against routine screening in 2012. Since that recommendation, a number of studies including two that were presented at the European Association of Urology meeting in March 2018 showing that with each passing year men are being diagnosed with prostate cancer at later stages and with more aggressive disease, which is likely to push up prostate cancer-specific mortality rates.

As an alternative to PSA screening, the PROMIS study published last year, showed that for men with high PSA, additional screening using a advanced type of MRI, called multi-parametric MRI (mpMRI) significantly reduced the number of unnecessary biopsies and increased detection of clinically significant cancers.

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