Pros and Cons of PSA Screening for Prostate Cancer

An updated Cochrane systematic review of five randomized controlled trials involving 341,342 men found that PSA-based prostate cancer screening did not significantly reduce prostate cancer-specific mortality or overall mortality when all studies were combined, although one major European study (ERSPC) showed a 21% reduction in prostate cancer deaths among men aged 55–69 years. Participants ranged from 45 to 80 years old and were followed for 7–20 years, with screening performed mainly using prostate-specific antigen (PSA) testing, sometimes combined with digital rectal examination. Overall pooled analysis showed no significant reduction in prostate cancer or all-cause mortality. Screening increased prostate cancer diagnoses by about 30%, especially localized cancers, while reducing advanced cancer diagnoses by about 20%. However, these benefits came with important harms, including frequent false-positive PSA results, unnecessary biopsies, bleeding, infection, pain, anxiety, erectile dysfunction, urinary incontinence, and substantial overdiagnosis and overtreatment; in the ERSPC study, up to 50% of screen-detected cancers may never have caused symptoms or death during a man’s lifetime. The review emphasized that any possible mortality benefit may take more than 10 years to appear, making screening unlikely to benefit men with a life expectancy under 10–15 years. Researchers concluded that men should receive balanced information about both the limited potential benefits and the considerable risks before deciding whether to undergo PSA screening. Source: https://www.cochranelibrary.com/