Early Prostate Cancer Detection Has Limited Benefits

Everybody would think that the earlier the detection of the prostate cancer is, the higher the patient's chances are, but a new study suggests that it all actually depends on the prostate specific antigen (PSA) levels within the blood.

A team of researchers led by Pim van Leeuwen, MD, of the Erasmus University Medical Center in Rotterdam, the Netherlands, wanted to find out if the baseline PSA can predict which men have most benefit from additional prostate cancer screening.

Among the 43,987 men aged 55 to 74 years who were enrolled between 1993 and 1999 in the European Randomized Study of Screening for Prostate Cancer (ERSPC) study in the Netherlands, Sweden, and Finland, scientists made a comparison between the incidence of prostate cancer and deaths from prostate cancer, depending on PSA levels.

Scientists also added 42,503 men in the same age range from Northern Ireland, whose PSA levels wee measured between 1994 and 1999.

All men were followed for prostate cancer and causes of death until 2006, and PSA levels were under 20ng/ml for all men at the beginning of the study.

During this time, 5,861 prostate cancers occurred and the death rates were higher for men with high PSA levels at the beginning of the study.

For men with PSA levels between 0 and 1.9ng/ml, a total of 24,642 men should be screened and 724 men should be treated for prostate cancer, in order to prevent one death.

For those with PSA levels between 10 and 19.9ng/ml, 133 men would have to be screened to prevent one death.

The conclusion of the study is that the PSA level before diagnosis predicts the degree of risk of dying from prostate cancer.

As for men between 55 and 74 with low PSA levels, aggressive follow-up testing and treatment are nearly useless, because they do not provide benefits and they might increase prostate cancer diagnosis as well as overtreatment and costs.

The authors say that “the greatest benefits of early detection programs may be when men, aged 55-74 years, are diagnosed and treated when their serum PSA is in the range 4.0-9.9 ng/ml or 10.0-19.9 ng/ml.

“Furthermore, following research efforts that recommend more intensive PSA based screening by lowering the PSA cut-off may greatly increase the number of men that need additional investigations and treatment, whilst having little effect on the reduction of prostate cancer mortality.”

Prostate cancer is the most often diagnosed malignancy and the third cause of death from cancer in men in Western countries.

Even if a man in the United State has about a one in six chance of being diagnosed with prostate cancer during his lifetime, the risk of dying from it is one in 36.

The study was published online in Cancer, a peer-reviewed journal of the American Cancer Society.