Medscape Medical News | August 15, 2012
A new approach to evaluating the benefits and harms of prostate-specific
antigen (PSA) testing "shows the way to a resolution of the
long-standing problem about screening for prostate cancer," according to
an editorial in the August 16th edition of The New England Journal of Medicine.
The new study, which is derived from statistical modeling, found that
the benefit of prostate cancer screening is "diminished" by the loss of
quality-adjusted life-years caused by overdiagnosis and
overtreatment.
Nevertheless, there is an average net benefit from screening in terms
of quality-adjusted life-years, according to the study authors, who are
led by Eveline Heijnsdijk, PhD, of the Erasmus Medical Center in
the Netherlands.
Annual screening of those between the ages of 55 and 69 years would result in:
- 9 fewer deaths from prostate cancer (28% mortality reduction);
- 14 fewer men receiving palliative therapy (35% reduction);
- a total of 73 life-years gained (an average of 8.4 years per prostate cancer death avoided).
However, the total number of quality-adjusted life-years gained from
screening in the group was lower (56 years) than the unadjusted (73
years) because of harms that men endure due to screening, they
report. Screening would also result in 45 men being overdiagnosed and
overtreated.
The authors calculated that to prevent one prostate cancer death, 98
men would have to be screened and 5 cancers would have to be detected.
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Thursday, August 16, 2012
Benefits of PSA testing may outweigh harms
Reuters Health | NEW YORK |
The possible benefits and harms of prostate cancer screening have been hotly debated in recent years, but for the first time a new study tries to put a number on the balance of pluses and minuses for the average man.
Using data from past cancer studies and a mathematical model, researchers from the Netherlands calculated that on average, annual screening using prostate-specific antigen (PSA) testing would add three healthy weeks to a man's life.
Whether screening has a net benefit or harm for a particular man depends on how he feels about the possibility of suffering screening- and treatment-related side effects - and how much erectile dysfunction or incontinence, for example, would influence his quality of life
Researchers considered the benefits of catching some cancers early - including a lower chance of dying from prostate cancer - as well as the harms of so-called overdiagnosis. Cancers caught during screening are considered overdiagnosis if they never would have produced symptoms or threatened a man's lifespan. In those cases, treatment can cause side effects but won't do men any good.
While the European study showed a 29-percent reduction in the chance of dying from prostate cancer in men who were screened, another large trial from the U.S. failed to show any survival benefit.
I note that some of the researchers have received consulting fees from pharmaceutical and medical device companies, including a company that designs PSA tests.
Read the full Reuters Health report
The possible benefits and harms of prostate cancer screening have been hotly debated in recent years, but for the first time a new study tries to put a number on the balance of pluses and minuses for the average man.
Using data from past cancer studies and a mathematical model, researchers from the Netherlands calculated that on average, annual screening using prostate-specific antigen (PSA) testing would add three healthy weeks to a man's life.
Whether screening has a net benefit or harm for a particular man depends on how he feels about the possibility of suffering screening- and treatment-related side effects - and how much erectile dysfunction or incontinence, for example, would influence his quality of life
Researchers considered the benefits of catching some cancers early - including a lower chance of dying from prostate cancer - as well as the harms of so-called overdiagnosis. Cancers caught during screening are considered overdiagnosis if they never would have produced symptoms or threatened a man's lifespan. In those cases, treatment can cause side effects but won't do men any good.
While the European study showed a 29-percent reduction in the chance of dying from prostate cancer in men who were screened, another large trial from the U.S. failed to show any survival benefit.
I note that some of the researchers have received consulting fees from pharmaceutical and medical device companies, including a company that designs PSA tests.
Read the full Reuters Health report
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