Efficacy, Safety of PSA Testing for Prostate Cancer Screening Investigated

Odds of choosing screening up for men with family history, African descent, low socioeconomic status
Odds of choosing screening up for men with family history, African descent, low socioeconomic status

(HealthDay News) — Prostate cancer screening with prostate-specific antigen (PSA) testing is not recommended, although certain groups of men are more likely to undergo testing, according to a review and recommendations published online Sept. 5 in The BMJ.

Dragan Ilic, Ph.D., from Monash University in Melbourne, Australia, and colleagues conducted a systematic review of five randomized trials with 721,718 men to examine the efficacy and safety of PSA testing for prostate cancer screening. The researchers found that screening probably has no impact on all-cause mortality (incidence rate ratio [IRR], 0.99; 95 percent confidence interval, 0.98 to 1.01) and may have no effect on prostate-specific mortality (IRR, 0.96; 95 percent confidence interval, 0.85 to 1.08).

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Based on these results, and considering the current evidence, Kari A.O. Tikkinen, M.D., Ph.D., from the University of Helsinki, and colleagues in an international panel translated the evidence into recommendations. The panel comprised patient partners, general practitioners, general internists, epidemiologists, methodologists, and statisticians. The panel recommend against systematic PSA screening (weak recommendation). Most men are expected to decline screening due to the small and uncertain benefit, and clear harms. However, the likelihood of choosing screening is increased among men with a family history of prostate cancer, of African descent or of low socioeconomic status, and with higher baseline risk of prostate cancer death. For men considering screening, shared decision-making is needed.

"Conversations with patients requesting a PSA test should explore their reasons for requesting a test and include evidence-based discussions about possible harms and benefits of PSA testing -- informed by the patient's ethnicity and family history -- and about recent advances in the use of multi-parametric magnetic resonance imaging and active surveillance, which have the potential to reduce the harms of testing," write the authors of an accompanying editorial.

Evidence Review
Rapid Recommendation