Routine screening for prostate cancer could reduce the number of people who die from the illness by around a fifth, according to findings from a major European trial.
Published in The Lancet, the results come from the European Randomised study of Screening for Prostate Cancer (ERSPC) which started in 1993 and has involved more than 162,000 men from eight countries.
The men (aged between 50 and 74 years) were randomly allocated to receive either PSA screening every 4 years or no screening at all. If a PSA level higher than 3.0 ng/ml was detected, they were referred for biopsy.
Results showed that at 9 years, screening had reduced the number of men that died from prostate cancer by 15%, with the figure increasing to 22% at l1 years. Over a further 13-year follow-up period, the relative reduction in death due to prostate cancer among those who were screened remained similar, at 21%.
Furthermore, the absolute benefit of screening rose steadily as follow-up continued. After 9 years, the number of men who needed to undergo screening in order for one death to be prevented was 1,410 but after 13 years, this number was reduced to 781.
Lead author Fritz Schröder, from the Erasmus University Medical Center in the Netherlands, said:
PSA screening delivers a substantial reduction in prostate cancer deaths, similar or greater than that reported in screening for breast cancer
However, Schröder and colleagues say doubts still remain about the value of screening and whether or not the benefits outweigh the risks. Over-diagnosis occurs in around 40% of cases detected by screening, which increases the risk of overtreatment and side-effects such as incontinence and impotence, they explain.
“Further research is urgently needed on ways to reduce over-diagnosis preferably by avoiding unnecessary biopsy procedures, and reducing the very large number of men who must be screened, biopsied, and treated to help only a few patients,” Schröder concludes.
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