Tags: Cancer | psa | prostate | cancer | death

PSA Test Lowers Risk of Prostate Cancer Death

By Nick Tate   |   Monday, 10 Mar 2014 04:34 PM

In a new study likely to reinvigorate the debate over the PSA test, researchers from Memorial Sloan Kettering Cancer Center have found areas where the screening is performed more frequently have lower death rates from prostate cancer than those where there is little testing.
The new research, published online in Journal of the National Cancer Institute, contradicts the findings of past studies that have raised questions about the benefits of PSA screening and undercut recent federal guidelines that recommend against routine testing for most men.

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The findings — by Sloan Kettering scientists, working with cancer specialists from the Umeå University, Sweden — are based on an analysis of national Swedish cancer registries. They show that prostate cancer incidence and mortality rates are markedly lower in areas with frequent use of PSA testing compared with regions where little screening is done, Medical Xpress reports.

"Our results show that prostate cancer mortality was 20 percent lower in counties with the highest incidence of prostate cancer, indicating an early and rapid uptake of PSA testing, compared with counties with a slow and late increase in PSA testing," said lead researcher Pär Stattin.
Håkan Jonsson, a statistician and senior author of the study, added that the findings are based on "real life PSA testing," as opposed to clinical trials, which have raised questions about the benefits of PSA screening.
"Since the difference in the number of men diagnosed with prostate cancer is related to how many men undergo PSA testing, we think our data shows that PSA testing and early treatment is related to a modest decrease in risk of prostate cancer death," Jonsson said.
"In contrast to screening in randomized studies our data is based on unorganized, real life PSA testing. We therefore used a statistical method that excludes men that were diagnosed prior to the introduction of PSA testing since these men could not benefit from the effect of PSA testing."
PSA (prostate-specific antigen) is a protein produced in the prostate gland that is measured in a blood test. Higher levels may signal prostate cancer, but other conditions can raise PSA, including a urinary tract infection, and inflammation or enlargement of the prostate.
PSA screening has been debated for years by prostate cancer specialists because it often catches low-risk cancers that patients are over-treated for with invasive biopsies and surgical removal of the prostate, a procedure that can leave men impotent and incontinent.
The American Urological Association recently recommended against PSA screening for average-risk men younger than 55 and older than 70. The U.S. Preventive Services Task Force has also recommended that men not get routinely screened using the PSA test. It said there was little evidence it saves lives, and can cause harm from the treatment of non-life threatening tumors.
But many men's health specialists and prostate cancer experts have argued the recommendations are ill-advised and that prostate tests — particularly went performed over time, which allows doctors to track trends and changes — are very effective in flagging men at risk.
"The results in our study are very similar to those obtained in a large European randomized clinical study [ERSPC] thus confirming the effect of PSA testing on the risk of prostate cancer death concludes," said Dr. Stattin.
"However, we have to bear in mind that the decrease in mortality is offset by overtreatment and side effects from early treatment. PSA testing sharply increases the risk of overtreatment, i.e. early treatment of cancers that would never have surfaced clinically.

We also know that after surgery for prostate cancer most men have decreased erectile function and that a small group of men suffer from urinary incontinence. Our data pinpoints the need for refined methods for PSA testing and improved prostate cancer treatment strategies."
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Memorial Sloan Kettering Cancer Center researchers have found areas where PSA screening is performed more frequently have lower death rates from prostate cancer than those where there is little testing.

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