The spontaneous PSA testing that has been applied in Sweden in recent decades has only had a marginal effect on mortality. An organized screening focused on those who have the most to gain would, however, reduce the risk of dying from prostate cancer by over 40 percent. This is shown by studies at the University of Gothenburg.
In Sweden, national programs for screening of both cervical cancer (Pap smear tests) and breast cancer (mammography) are applied. A corresponding program for the screening of prostate cancer does not exist.
Opportunistic screening
Many men instead have PSA tests on their own initiative, so-called opportunistic screening. However, there is no national recommendation on how such a test program should be formulated.
In several large studies, researchers at the Sahlgrenska Academy, University of Gothenburg, have tested organized PSA screening of 10,000 randomly chosen men in the Gothenburg region, and compared with the outcome in opportunistic screening.
Reduces risk of dying
The studies show that an organized test program both identifies more cancer cases in an early, curable phase and sharply reduces the risk of dying:
- In the group of men that was offered organized PSA screening, the risk of dying from prostate cancer decreased by 42 percent. In the group that was exposed to opportunistic screening, only a marginally reduced mortality was seen.
- Converted to a calculation example, one prostate cancer death per 13 men diagnosed with prostate cancer was prevented in organized screening compared with one prostate cancer death per 23 diagnosed men prevented in opportunistic screening.
Small effects
"The opportunistic PSA screening that we have used in Sweden for 20 years is simply not effective, and has only marginally reduced the risk of men dying from the disease," says Rebecka Arnsrud Godtman who is publishing the studies in her dissertation.
The opportunistic screening also leads to a larger proportion of men being unnecessarily diagnosed with prostate cancer. Besides the mental strain from being diagnosed with cancer, these men are at risk of living with the side-effects of a treatment for the rest of their lives, without actually getting any positive effects, according to Rebecka Arnsrud Godtman.
Active surveillance
The Gothenburg researchers' conclusion is that the PSA screening in Sweden should take place in an organized program where men are regularly invited for tests. Screening should start at a relatively young age, around 50, and take place with frequent checks. To minimize the risks of overdiagnosis, older men and men with other diseases should not undergo PSA screening.
The risk of overtreatment can be reduced through so-called active surveillance, where diagnosed men are under careful observation and only treated if the tumor shows signs of becoming more aggressive. According to the dissertation, a full 60 percent of the tumors found in organized PSA screening can be handled with active monitoring.
Explore further: Prostate cancer mortality benefit seen for family Hx-based screens
More information: Link to dissertation: http://ift.tt/1zOEVga
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The spontaneous PSA testing that has been applied in Sweden in recent decades has only had a marginal effect on mortality. An organized screening focused on those who have the most to gain would, however, reduce the risk of dying from prostate cancer by over 40 percent. This is shown by studies at the University of Gothenburg.
In Sweden, national programs for screening of both cervical cancer (Pap smear tests) and breast cancer (mammography) are applied. A corresponding program for the screening of prostate cancer does not exist.
Opportunistic screening
Many men instead have PSA tests on their own initiative, so-called opportunistic screening. However, there is no national recommendation on how such a test program should be formulated.
In several large studies, researchers at the Sahlgrenska Academy, University of Gothenburg, have tested organized PSA screening of 10,000 randomly chosen men in the Gothenburg region, and compared with the outcome in opportunistic screening.
Reduces risk of dying
The studies show that an organized test program both identifies more cancer cases in an early, curable phase and sharply reduces the risk of dying:
- In the group of men that was offered organized PSA screening, the risk of dying from prostate cancer decreased by 42 percent. In the group that was exposed to opportunistic screening, only a marginally reduced mortality was seen.
- Converted to a calculation example, one prostate cancer death per 13 men diagnosed with prostate cancer was prevented in organized screening compared with one prostate cancer death per 23 diagnosed men prevented in opportunistic screening.
Small effects
"The opportunistic PSA screening that we have used in Sweden for 20 years is simply not effective, and has only marginally reduced the risk of men dying from the disease," says Rebecka Arnsrud Godtman who is publishing the studies in her dissertation.
The opportunistic screening also leads to a larger proportion of men being unnecessarily diagnosed with prostate cancer. Besides the mental strain from being diagnosed with cancer, these men are at risk of living with the side-effects of a treatment for the rest of their lives, without actually getting any positive effects, according to Rebecka Arnsrud Godtman.
Active surveillance
The Gothenburg researchers' conclusion is that the PSA screening in Sweden should take place in an organized program where men are regularly invited for tests. Screening should start at a relatively young age, around 50, and take place with frequent checks. To minimize the risks of overdiagnosis, older men and men with other diseases should not undergo PSA screening.
The risk of overtreatment can be reduced through so-called active surveillance, where diagnosed men are under careful observation and only treated if the tumor shows signs of becoming more aggressive. According to the dissertation, a full 60 percent of the tumors found in organized PSA screening can be handled with active monitoring.
Explore further: Prostate cancer mortality benefit seen for family Hx-based screens
More information: Link to dissertation: http://ift.tt/1zOEVga
Medical Xpress on facebook
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Active surveillance can reduce suffering among men with prostate cancer
Nov 02, 2012
With active surveillance many men with prostate cancer could dispense with radiation treatment and surgery, and thus avoid adverse effects such as incontinence and impotence. This is the outcome of a study of almost 1,000 ...
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Prostate cancer screening using the prostate-specific antigen (PSA) test is widely used in France despite a lack of evidence showing that it reduces cancer deaths. Now, researchers have shown that men experience more harm ...
Prostate cancer mortality benefit seen for family Hx-based screens
Jan 19, 2015
(HealthDay)—Screening white men with a family history of prostate cancer appears to be associated with a decrease in prostate cancer-specific mortality, according to a study published in the January issue ...
Four reasons I won't have a prostate cancer blood test
Dec 11, 2014
Cancer Council Australia and the Prostate Cancer Foundation of Australia yesterday released new draft guidelines to help GPs counsel men who ask about prostate cancer tests. They advise GPs to explain the ...
Alternative PSA screening strategies could reduce harm
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(HealthDay)—Compared with standard screening, alternative prostate-specific antigen (PSA) screening strategies could maintain good prostate cancer detection rates while reducing overdiagnoses and unnecessary ...
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