UPDATE - Issue 37 - Summer 2009
Screening for prostate cancer
The publication of two landmark studies on screening for prostate cancer might have settled the debate on this issue. Unfortunately, they came to different conclusions. The European study (ERSPCS) involving 182,000 men demonstrated a 27% reduction in mortality in the screened arm of the study while, by contrast, the US based PLC screening study of 76,693 men reported no difference between the two arms at 9 years. However, there are several important differences between the two studies that may account for the discrepancy.
The European study was based on a PSA cut-off point of 3.0ng/ml rather than the 4.0ng/ml value selected for the US study as a trigger for further investigations. This may have allowed the Europeans to identify more cancers at a stage when they were still curable. Another problem with the US-based PLC study of 76,693 men is the pre-existent widespread use of PSA screening within the population. This has led to the contamination of the non-screened arm by men who went and had their PSA tested outside the study. Clearly this will have significantly reduced the power of the trial to detect a difference between the two arms, especially since the US study recruited less than half the number of patients than the European group.
Thus the jury remains out on this issue, but urologists and oncologists whose aim it is to reduce the death toll from prostate cancer will be encouraged that in the UK alone on the basis of the European study data 2,700 lives could potentially be saved each year. The discouraging fact that both the Department of Health and the European Association of Urologists have noted is that for every life saved, 1400 would undergo screening and 48 would be treated for non life threatening cancers. The UK national screening committee is due to consider these findings in the next two months.
In the meantime men are left with some hard decisions to make on personal risks and benefits when considering whether to ask for a PSA test.
In response to this situation Prostate UK have supported the Prostate Cancer Patient Support Federation in publishing new guidance for men on this matter.
For more detail on the studies please visit our web site.