Single PSA Screening Does Not Improve Prostate Cancer-Related Mortality

Share this content:
Recommendations about population-wide PSA screening are mixed, with some studies suggesting that the potential benefits of early diagnosis are outweighed by overtreatment.
Recommendations about population-wide PSA screening are mixed, with some studies suggesting that the potential benefits of early diagnosis are outweighed by overtreatment.

A single prostate-specific antigen (PSA) screening may not improve the 10-year rate of prostate cancer–specific survival, though low-risk disease is more likely to be detected, according to research published in JAMA Oncology.1

Recommendations about population-wide PSA screening are mixed, with some studies suggesting that the potential benefits of early diagnosis are outweighed by overtreatment. No major study has, however, determined whether a single PSA screening is likely to benefit patients over a long follow-up period.

For this study (the Cluster Randomized Trial of PSA Testing for Prostate Cancer; CAP), researchers attempted to “determine the effects of a low-intensity, single invitation PSA test and standardized diagnostic pathway on prostate cancer–specific and all-cause mortality while minimizing overdetection and overtreatment.”

Of over 415,000 enrolled patients, 189,366 were randomly assigned to undergo a single PSA test (intervention group) and 219,439 were assigned to a control group. The mean age was 58.5 years vs 58.6 years in the intervention vs the control group, respectively; 3.6% vs 3.7% of patients had diabetes and 8% vs 7.8% of patients were obese.

Of patients assigned to the intervention group, 64,436 underwent PSA testing and had a valid result. Eleven percent of these patients had a PSA level between 3 ng/mL and 19.9 ng/mL; 85% of patients in this PSA range underwent biopsy.

The median follow-up was 10 years; during this period, 549 patients in the intervention group and 647 patients in the control group died of prostate cancer (rate ratio [RR] for deaths per 1000 person-years, 0.96; P = .5). More patients in the intervention group were, however, diagnosed with prostate cancer during follow-up (8054 vs 7853; RR, 1.19; P < .001).

Prostate cancers diagnosed in the intervention group were, furthermore, more likely to have a Gleason grade of 6 or lower.

The rate of all-cause mortality was also similar between the groups: at 10 years, 25,459 patients in the intervention group and 28,306 patients in the control group had died (RR, 0.99; P = .49).

The authors concluded that “there was no significant difference in prostate cancer mortality after a median follow-up of 10 years but the detection of low-risk prostate cancer cases increased. Although longer-term follow-up is under way, the findings do not support single PSA testing for population-based screening.”

Reference

  1. Martin RM, Donovan JL, Turner EL, et al. Effect of a low-intensity PSA-based screening intervention on prostate cancer mortality: the CAP randomized clinical trial. JAMA Oncol. 2018 Mar 6. doi: 10.1001/jama.2018.0154 [Epub ahead of print]

Related Resources

You must be a registered member of Cancer Therapy Advisor to post a comment.

Sign Up for Free e-newsletters



Regimen and Drug Listings

GET FULL LISTINGS OF TREATMENT Regimens and Drug INFORMATION

Bone Cancer Regimens Drugs
Brain Cancer Regimens Drugs
Breast Cancer Regimens Drugs
Endocrine Cancer Regimens Drugs
Gastrointestinal Cancer Regimens Drugs
Gynecologic Cancer Regimens Drugs
Head and Neck Cancer Regimens Drugs
Hematologic Cancer Regimens Drugs
Lung Cancer Regimens Drugs
Other Cancers Regimens
Prostate Cancer Regimens Drugs
Rare Cancers Regimens
Renal Cell Carcinoma Regimens Drugs
Skin Cancer Regimens Drugs
Urologic Cancers Regimens Drugs