Focusing prostate cancer testing on men at highest risk of developing the disease is likely to improve the ratio between benefits and the harms of screening, suggests a paper published on bmj.com Prostate specific antigen (PSA) screening is widely used for the early detection of prostate cancer.
There is now evidence that PSA screening can reduce prostate cancer mortality in men who would not otherwise be screened. However, this can come at considerable harm. Researchers from Sweden and the USA carried out a case-control study taking data from the Malmo Preventative Project (MPP) cohort, in an attempt to develop an evidencebased scheme for prostate cancer testing. They focused their studies on men close to age 40, mid-to-late forties (45-49) and early-tomid fifties (51-55). Within 25 to 30 years, 44% of deaths from prostate cancer occurred in those with the top 10% of PSA levels at age 45-49, a PSA of about 1.5ng/mL or more. The risk of prostate cancer death was more than 10 times greater in this group, compared to men with the lowest 25% of PSA levels. The researchers conclude that PSA levels are informative of the current risk of cancer as well as being ‘predictive of the future risk of prostate cancer’ and any cancer-specific death. They say that screening programmes can be designed to reduce the risk of over-diagnosis while still enabling early cancer detection for men at highest risk of death from prostate cancer.
