Mar 30, 2012 - 4:22 pm
March 15, 2012 - While the debate over the value of PSA screening continues, European researchers have released data from two additional years of follow up in the European Randomized Study of Screening for Prostate Cancer. Their conclusion: those who were screened for PSA had a 21 percent lower risk of dying from the disease compared to those who weren’t.
The results of the study were published in the New England Journal of Medicine yesterday.
When the initial data from the European study was released three years ago, it also indicated that PSA screening saved lives. But opponents of PSA screening were quick to cite a U.S.-based PLCO study showing there was no significant benefit with screening. But there were inherent differences in the design of the studies making it difficult to draw comparisons and conclusions. The PLCO followed about half the amount of men compared to the European study and for half the time.
The European study is the best designed study of its kind in that it was truly randomized in a PSA screening “naïve” population. That study has not been conducted in the U.S. due the fact that PSA-screening is wide-spread in this country. In the European randomized study of screening for prostate cancer, the rate of over diagnosis was 50%., underscoring the urgent need for more specific biomarkers in urine- and blood-based tests.
“Better constructed studies, deliver more interpretable data,” explains Jonathan Simons, MD, president and CEO of the Prostate Cancer Foundation. “The European study provides more conclusive data because of the size of its patient sample and its extended follow up time. We hope policy makers and physicians will take a close look at this study, and use the updated data to best inform decisions with patients regarding the benefits and risks of screening for prostate cancer.”
Another European study, the Göteborg Randomised Population Based Prostate-Cancer Screening Trial showed that over 14 years, PSA screening reduced prostate cancer mortality by nearly half. This study followed 20,000 Swedish men and its data were published in July 2010.
Researchers sponsored by PCF weighed in on the findings.
“Men who choose to be screened should be prepared for a tough discussion of whether to have a biopsy or to treat any cancer that is found,” said Dr. Christopher Logothetis, prostate cancer research chief at the University of Texas MD Anderson Cancer Center in Houston.
"Urologists are very passionate about it (screening) because we see all the bad cases," said Dr. Stephen Freedland, a Duke University urologist who has consulted for a few makers of prostate cancer drugs. "What we need to do is separate screening from treatment. Not everyone diagnosed needs to be treated. But the best way of knowing who to treat is getting a sense of how bad the cancer is," he said. Annual tests may be too often, "but I don't think the solution to that is to give up all screening."