Prostate cancer screening can lead to men facing unnecessary treatment, study finds

Prostate cancer is one of the most common cancers in men.

Screening for prostate cancer with a blood test can save men’s lives, but the “absolute benefit is small” and many men could face unnecessary treatment and medical complications, according to the most comprehensive study yet.

In a review that analysed six trials involving nearly 800,000 men, screening with the prostate-specific antigen (PSA) test reduced prostate cancer deaths by two for every 1,000 men screened, meaning 500 men must be screened to prevent one death from the disease.

The benefit became apparent as patients were monitored for longer periods, in particular during the European randomised study of screening for prostate cancer (ERSPC), which followed men for 23 years after screening.

“Prostate cancer screening does reduce prostate cancer mortality, although the caveat is that it takes a very extended period of time to realise that benefit,” said Prof Philipp Dahm, a urologist at the University of Minnesota and senior author of the Cochrane review. 

“This finding is a milestone and I think it will make a difference for a lot of policymakers.”

Many countries have no formal prostate cancer screening programmes, largely because the PSA test is unreliable. As well as picking up life-threatening tumours, it detects a lot of benign cancers that may never cause problems. This can result in men having radiotherapy, surgery or hormone therapy, putting them at risk of complications such as incontinence and impotence.

The studies in the review did not systematically assess the impact of screening on men’s quality of life, but the ProtecT trial found between 8% and 47% of men reported problems with urinary or sexual function after radiotherapy or surgery for prostate cancer.

Dr Juan Franco at Heinrich Heine University in Düsseldorf, the first author of the review, said the results were “not a blanket endorsement of universal screening” and stressed the “very real risks” of overdiagnosis and unnecessary treatment. 

“It’s important to have, ultimately, discussion with patients, and what we call shared decision-making,” he said.

Prostate cancer is one of the most common cancers in men.

Dahm said screening made more sense when men were expected to live for at least another 10 to 15 years. 

“If you have a lot of competing medical comorbidities that are much more likely to limit your life expectancy, you just don’t have to worry about prostate cancer for the most part, because most prostate cancer is slow growing,” he said.

The review also examined recent advances in screening that aim to be more precise and reduce unnecessary biopsies by testing for more prostate-related proteins in the blood and using MRI scans to image the gland. While those look promising, the researchers said it was too early to know if they could save more lives or cause less harm.

The Guardian