Limited prostate Ca screening may be beneficial

Screening for prostate cancer has significant drawbacks, but limited screening could be beneficial, according to an analysis of results from a large European study.

Participating in the screening of men aged 55 to 69 years every 4 years reduces the risk of death from the disease by 32%, reported the authors, who published their findings in the New England Journal of Medicine (2012; 367:595-605). The authors did not recommend screening in men over 70 years of age, as treatment of prostate cancer in these men would unnecessarily reduce the quality of life.

Researchers from the public health department of the Erasmus Medical Center, Rotterdam, the Netherlands, analyzed data from the European Randomized Study of Screening for Prostate Cancer (ERSPC), which was carried out among 162,000 men. Led by Harry de Koning, PhD, the authors adjusted the potential health gains for all the expected disadvantages of short-term and long-term screening, taking into account the consequences for the quality of life of the participants.

"Previous publications by the ERSPC had already shown that screening of men could be useful. What is new and unique is the fact that using a computer model, we can look much further than the 11-year follow up period from the ERSPC trial," said first author Eveline Heijnsdijk, PhD. "Furthermore, we have included the quality of life."

By correctly taking into account a longer follow-up period, the drawbacks can be calculated more accurately. For example, the ERSPC published that in the first 11-year follow up, 1,055 screenings were needed to prevent one death.

"In our case, a lifelong follow-up would mean that only 129 men would have to be screened to prevent one death as a result of the disease," Dr. de Koning said. “We have made a very important step. We were one of the first to criticize the screening program for prostate cancer, but the favorable long-term effects are promising.

"The drawbacks reduce this beneficial effect by about 20%," but public health officials and individual patients will have to decide over the coming years whether this is too much or too little, he said.

"This study has two important implications," commented Harold C. Sox, MD, of Dartmouth Institute for Health Policy & Clinical Practice, Hanover, NH, in an editorial accompanying the study (N Engl J Med 2012; 367:669-71). "It reminds us in stark terms that decisions about PSA screening depend in part on how the patient feels about the downstream consequences of screening, a fact that is easily forgotten in the stress of daily office practice. More important, however, this study is a model for developing the evidence base for practice guidelines."

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