PSA screening cuts deaths by 20%, says world's largest prostate cancer study

20 Mar 2009

UK Chief Medical Officer contacts all GPs to highlight the findings of two major studies into the effectiveness of prostate cancer screening; Government asks the UK National Screening Committee to review the new findings

Screening for prostate cancer can reduce deaths by 20%, according to the results of the European Randomized Study of Screening for Prostate Cancer (ERSPC) published online in the New England Journal of Medicine. ERSPC is the world's largest prostate cancer screening study and provides robust, independently audited evidence, for the first time, of the effect of screening on prostate cancer mortality.

The study commenced in the early 1990s involving eight countries - Belgium, Finland, France, Italy, Netherlands, Spain, Sweden and Switzerland - with an overall follow-up of up to 12 years. Participants totalled 182,000 but then narrowed down to 162,000 men in seven countries, aged 55-69; only those who had not been screened could take part. The findings are being unveiled at the 24th Annual Congress of the European Association of Urology (EAU) in Stockholm.

By initially screening men 55 to 69 years with the PSA marker and offering regular follow up, this led to an increase in early detection. Deaths due to metastasized disease were then reduced. Exact data showed that on average for every 1,408 men screened, 48 had cancer diagnosed and received treatment, resulting in saving one life. Screening took place on average every four years with a mean follow-up over nine years. The cut-off value was a PSA level of 3.0 ng/ml or more. Men with this reading were then offered a biopsy.

Prof Fritz Schroder, international coordinator of the ERSPC study explained: "The study shows that PSA screening delivers a 20% reduction in mortality from prostate cancer. This provides decision makers on screening policies with important new data on the effectiveness of PSA testing in preventing deaths."

"However, the ERSPC is also near to completing additional studies on quality of life and cost-effectiveness and these must be assessed before making a decision about the appropriateness of a national prostate screening policy."

Worldwide, prostate cancer is the second leading cause of cancer death. Separate ERSPC findings already confirm that approximately 30% of detected cancers actually have non-aggressive features and are 'indolent' or slow growing. This overdiagnosis is an unavoidable effect from all cancer screening procedures. With prostate cancer, a new, more conservative form of monitoring, 'Active Surveillance', might be an important method to help avoid early invasive treatment.

"Professor Peter Johnson, Cancer Research UK's chief clinician, said: "This important European study has shown that PSA tests can detect very early prostate cancer and could reduce the number of men who die from the disease by up to 20 per cent. But it's very difficult to prove even in large trials like this that PSA screening has a direct impact on reducing cancer deaths, so we need to see what the results will be with longer follow up.

"For some men, detecting prostate cancer early through screening can be life saving while for others it will lead to unnecessary treatment and side effects like impotence and incontinence. But the important thing is that men in their 50s and 60s discuss this with their doctor and feel able to request a PSA test easily."

Harpal Kumar, Cancer Research UK's chief executive, added: "Despite the risks of unnecessary treatment, more men as a result of this study will want a PSA test. The government should begin a feasibility study to assess the implications for screening and treatment.

We still don't know what the best treatment approach is for early disease, so it's important we find answers to this as soon as possible through research currently funded by Cancer Research UK and others. Scientists also need to accelerate their efforts to find markers to distinguish between slow growing and aggressive forms of prostate cancer so that we know which ones to treat and which ones are best to monitor."

John Neate, Chief Executive of The Prostate Cancer Charity, said: "We support the Chief Medical OfficerÌs decision to alert all GPÌs to these new research findings and to the Prostate Cancer Risk Management Programme, aimed at providing advice to GPs on how to counsel men who request a PSA test but have no symptoms. Undoubtedly, given the significance of the new studies and the Government's decision to ask the UK National Screening Committee to review this new evidence, many men will now be more aware of the PSA test and may be seeking access to this."