Prostate Test: No Survival Benefit?
Men Who Died Had PSA Cancer Screening Test as Often as Those Who Lived
WebMD News Archive
No Survival Advantage Seen
From approximately 72,000 veterans receiving care at 10 VA medical centers
in New England, Concato and colleagues identified 501 men aged 50 and older who
were diagnosed with prostate cancer between 1991 and 1995 and had died of the
disease by 1999. An equal number of living VA patients, matched for age and
place of treatment, were included in the study as a comparison group.
The researchers found that 14% of the men who died of prostate cancer and
13% of those who did not die had been screened using the PSA test. The overall
risk for death after adjusting for race and coexisting medical conditions
showed no increased risk.
"If screening worked, men who died would have had less testing than
those who lived," says Concato.
The Yale University professor of medicine suggests that men with strong
fears of prostate cancer and those who fully understand the potential risks
associated with treatment may still want to have routine PSA testing.
Informed men who feel the potential risks outweigh the benefits should not
be pressured into having the test, he says.
"Doctors should mention that the PSA test isn't perfect and that
screening may lead to possible harm as well as potential benefit," he says.
"The benefits include the potential for improved survival in some men. The
harms include possible treatment-related side effects, including incontinence
and impotence, for therapies that may be unnecessary (for slow growing tumors)
or ineffective (for aggressive ones)."
In an editorial accompanying the study, Michael J. Barry, MD, of
Massachusetts General Hospital, wrote that it remains to be seen if PSA testing
results in improved prostate cancer survival.
Two large clinical trials under way in the United States and in Europe
should provide more definitive answers, he says. The results of these studies
should give more information about the effectiveness of prostate cancer
screening. Results from the trials are expected sometime in 2009.
"I have been writing that we need to wait for trials to see if prostate
cancer screening does more good than harm for so long, sometimes I despair of
ever knowing the answer," he writes, adding that "help is now not that