The recent changes in prostate-specific antigen (PSA) screening guidelines in the United States have been fueling debate among clinicians. The current recommendations are to not screen asymptomatic men unless otherwise indicated.

Now, a new Swedish study is suggesting that this approach could lead to a significant problem of undertreatment and a greater incidence of prostate cancer-related mortality.

Researchers have found that the spontaneous PSA testing that has been applied in Sweden in recent decades has only had a marginal effect on mortality.

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However, studies conducted at the University of Gothenburg in Sweden suggest an organized screening program focused on those men who have the most to gain would reduce the risk of dying from prostate cancer by 40%.1

In Sweden, national programs for screening of both cervical cancer (Pap smear tests) and breast cancer (mammography) are in place, but a corresponding program for the screening of prostate cancer does not exist. Currently, many men in Sweden have PSA screening only through their own initiative (opportunistic screening).

In several large studies, researchers at the Sahlgrenska Academy at the University of Gothenburg tested organized PSA screening of 10,000 randomly chosen men in the Gothenburg region, and compared that approach with the outcomes in opportunistic screening. The studies showed that an organized screening program both identifies more cancer cases in an early, curable phase and sharply reduces the risk of dying.

The analyses showed that in the group of men that was offered organized PSA screening, the risk of dying from prostate cancer decreased by 42%.

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However, only a marginally reduced mortality was seen in the group that was exposed to opportunistic screening. The analysis showed that one prostate cancer death per 13 men diagnosed with prostate cancer was prevented in organized screening compared with one prostate cancer death per 23 diagnosed men prevented in opportunistic screening.

Study investigator Rebecka Arnsrud Godtman reports that the opportunistic PSA screening that has been used in Sweden for 20 years “is simply not effective, and has only marginally reduced the risk of men dying from the disease.”

She contends that opportunistic screening also leads to a larger proportion of men being unnecessarily diagnosed with prostate cancer. Besides the mental strain from being diagnosed with cancer, these men are at risk of living with the side-effects of a treatment for the rest of their lives, without actually getting any positive effects, according to Rebecka Arnsrud Godtman.