According to new research, annual prostate cancer screening among men in their 50s and 60s and those with underlying health conditions does not reduce deaths from the disease.
Researchers at Washington University School of Medicine in St. Louis conducted a longer follow-up of more than 76,000 men in a major US study. Results show that 6 years of annual screening for prostate cancer led to more diagnoses of tumors but did not reduce deaths from the disease. The updated outcomes of the Prostate, Lung, Cancer, Colorectal and Ovarian (PLCO) Cancer Screening Trial were published online in the Journal of the National Cancer Institute.
The study’s lead author and principal investigator Gerald Andriole, MD, chief urologic surgeon at the Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine says, “The data confirm that for most men, it is not necessary to be screened annually for prostate cancer. A large majority of the cancers we found are slow-growing tumors that are unlikely to be deadly.”
The PLCO study involved men aged 55 to 74 years. Patients were randomly assigned to receive either annual PSA tests for 6 years and digital rectal exams for 4 years or routine care involving only physician-recommended screening tests.
Among the men screened annually, 12% more prostate tumors were discovered compared with those who received routine care. However, deaths from prostate cancer did not differ significantly between the groups. In addition, men with a history of cancer, diabetes, heart attacks, strokes, or lung and liver disease who were also diagnosed with prostate cancer were far more likely to die of causes other than prostate cancer. This finding suggests that screening often detects tumors that are not likely to cause harm.
In an earlier publication of the data in a 2009 issue of the New England Journal of Medicine, when nearly all men had been followed for 7 years, Andriole and his colleagues reported no mortality benefit from prostate cancer screening.
“Now, based on our updated results with nearly all men followed for 10 years and more than half for 13 years, we are learning that only the youngest men – those with the longest life expectancy – are apt to benefit from screening. We need to modify our current practices and stop screening elderly men and those with a limited life expectancy,” says Andriole, who also is the Robert K. Royce Distinguished Professor. “Instead, we need to take a more targeted approach and selectively screen men who are young and healthy and particularly those at high risk for prostate cancer, including African-Americans and those with a family history of the disease.”
Since recent studies have indicated that elevated PSA levels among men in their early 40s can predict the risk of prostate cancer in later years, Andriole recommends that men get a baseline PSA test in their early 40s.
According to Andriole, “We have to take a more nuanced approach to determine which men should be screened with PSA in the first place, how frequently they should be tested, the PSA level at which they should be biopsied and whether their cancer warrants aggressive therapy.”
Source: Washington University St. Louis.