Single PSA screening increases prostate cancer detection but does not change mortality

1. In this randomized controlled trial, men who were screened with a single PSA test had higher diagnoses of prostate cancer than those who were unscreened.

2. There was no difference in mortality between the two groups.

Evidence Rating Level: 1 (Excellent)

Study Rundown: In the era of prostate-specific antigen (PSA) screening, there has been a clear reduction in deaths due to prostate cancer. However, there is continued discussion regarding the mortality benefit derived from PSA screening versus the risk of overdetection and overtreatment of prostate cancer. In this randomized controlled trial, men aged 50 to 69 received an invitation to take a single PSA test or were unscreened. Prostate cancer detection was higher in the PSA group, but there was no difference in prostate cancer mortality or all-cause mortality between groups.

While this study suggests that a single PSA screening is unlikely to provide long-term benefits, and the conclusions of the study are supported by a large sample size, there are some major limitations. Most notably, only 40% of patients in the PSA intervention group chose to receive the PSA test. In addition, a median follow-up of 10 years may be too short to see the long-term benefits of PSA screening. Finally, it remains unknown if multiple rounds of PSA testing, as was performed in other international trials, would have resulted in lower mortality rates in this patient population.

Click to read the study, published in JAMA

Relevant Reading: Screening and prostate-cancer mortality in a randomized European study

In-Depth [randomized controlled trial]: This study randomized 415 357 men aged 50 to 69 years at 573 primary care practices across the United Kingdom to an invitation to attend a PSA testing clinic and receive a single PSA test versus standard unscreened practice. Men in the intervention group who had a PSA level of 3 or greater were offered a standardized 10-core transrectal ultrasound-guided biopsy. 11% had a PSA level between 3 and 19.9, of whom 85% had a prostate biopsy. Prostate cancer detection was higher in the PSA group at 4.3% versus 3.6% in the control group (RR 1.19; CI₉₅ 1.14-1.25). However, there was no difference in prostate cancer-specific mortality between groups at a median follow-up of 10 years (RR 0.96; CI₉₅ 0.85 to 1.08)  nor all-cause mortality between groups at 10 years (RR 0.99; CI₉₅ 0.94 to 1.03).

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