Screening saves lives, study finds

After years of growing doubt about the value of screening men for prostate cancer, a new analysis of existing clinical trial evidence has found that when men between 55 and 70 get the prostate-specific antigen, or PSA, test, the result is lives saved.

In 2009, a New England Journal of Medicine editorialist famously called the debate over PSA testing for prostate cancer “the controversy that refuses to die.” That comment came with the publication of two clinical trials — one conducted in the United States, the second in Europe — that drew two contradictory conclusions on prostate cancer testing.

The U.S. undertaking, called the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial, found that screening men for prostate cancer does not save lives. The European Randomized Study of Screening for Prostate Cancer suggested that screening drove down the rate of deaths from prostate cancer by 20 percent.

In 2012, a federally funded panel of experts on preventive care concluded there are more risks than benefits to screening American men for prostate cancer with the PSA test. And in April 2017, the U.S. Preventive Services Task Force dumped the decision squarely into the laps of patients and their doctors. Some men between 55 and 69 years of age might well decide to get their PSA checked, the task force said. After hearing the ledger of pros and cons, however, others in that age bracket might just as reasonably skip the screening test, the panel concluded.

The new research, published this week in the Annals of Internal Medicine, now calls those recommendations into question. The authors of the study, led by bio-statistician Ruth Etzioni of the Fred Hutchinson Cancer Research Center in Seattle, concluded that screening men over age 55 “can significantly reduce the risk for prostate cancer death.”

When men who fit the criteria for screening get the PSA test, the reduction in deaths due to prostate cancer was between 25 and 32 percent, the new study found.

But the newly published analysis also underscores that the value of prostate cancer screening rests heavily on which men you screen, where and for how long you conduct the clinical trial, and how you crunch the numbers.