Research demonstrates 13% relative reduction in prostate cancer deaths but highlights overdiagnosis concerns, prompting calls for risk-based screening approaches.
A large-scale European study has confirmed that prostate-specific antigen (PSA) screening produces a sustained long-term reduction in prostate cancer mortality, with findings showing a 13% relative reduction in deaths 23 years after screening initiation.
The European Randomized Study of Screening for Prostate Cancer (ERSPC), published in the New England Journal of Medicine, followed more than 160,000 men from eight European countries and found that one death from prostate cancer was prevented for every 456 men invited for screening compared to those who were not invited.
“Long-term follow-up demonstrates that PSA screening can substantially reduce deaths from prostate cancer,” says Anssi Auvinen, PhD, professor of epidemiology at Tampere University and one of the study’s principal investigators, in a release. “Yet, the effect starts to wane once screening is discontinued and largely disappears within nine years.”
Screening Benefits Increase Over Time
The study revealed that the absolute benefit of PSA screening improved over the follow-up period. After 16 years, one death was prevented for every 628 men invited for screening, but by the study’s end at 23 years, only 456 men needed to be invited to prevent one death. Within the screening group, researchers found one death was prevented for every 12 men diagnosed with the disease.
The screening program led to detection of a higher number of low-risk cancers but fewer cases of advanced cancers. Initial PSA tests showed elevated levels in 16% of participants, but subsequent biopsies confirmed prostate cancer in only 24% of those men, indicating that a considerable number of tests and procedures may have been unnecessary.
Overdiagnosis Remains Key Concern
Despite the mortality benefits, the study highlighted significant overdiagnosis issues associated with PSA screening. Some prostate cancers are slow-growing and do not become symptomatic even if left untreated, meaning treatment of these indolent, low-risk cancers offers no benefit to patients while potentially reducing quality of life through side effects.
The PSA level determined by screening tests proved to be an effective predictor of both prostate cancer risk and the likelihood of death from the disease.
Risk-Based Screening Approaches Advocated
To address overdiagnosis concerns, researchers advocate for developing risk-based screening approaches. Since the ERSPC study began in the mid-1990s, substantial progress has been made with such approaches, including the use of magnetic resonance imaging to help reduce overdiagnosis.
“Risk-based screening would enable the identification of men who are at the highest risk of developing a clinically significant prostate cancer,” says Auvinen in a release.
The study was led by Erasmus University Medical Centre in Rotterdam, Netherlands, with Finnish partners including Tampere University, Tampere University Hospital, University of Helsinki, Helsinki University Hospital, and the Finnish Cancer Registry. Nearly half of the study participants were from Finland.
Prostate cancer is the most common cancer in men and the second-leading cause of cancer death in men in Finland and third-leading in Europe. Finland currently has no national screening program for prostate cancer, though PSA screening introduction has become a topic of healthcare policy debate.
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