Abstract
The benefits and harms from the use of prostate-specific antigen (PSA) as a screening test are reviewed in the light of the updated results from two major randomized trials of screening for prostate cancer, the prostate component of the Prostate, Lung, Colon and Ovary (PLCO) trial in the United States and the European Randomized Study of Screening for Prostate Cancer (ERSPC). Neither trial found a reduction in prostate cancer mortality during the first 7 years after initiation of screening, and this lack of benefit persisted through 13 years for PLCO. In ERSPC, however, lower mortality from prostate cancer emerged after 7 years in the screening group compared to the control resulting in a 21 % significant reduction in prostate cancer mortality for the core group of subjects (aged 55–69) by the end of the reported follow-up (median 11 years) though differences in treatment of prostate cancer in the control group compared to those detected in the screening group could have been responsible for this mortality differential. Currently, there is no justification for the introduction of population-based organized screening for prostate cancer at any age; while in view of the potential harms associated with screening, physicians should generally recommend against PSA testing for asymptomatic men.
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References
American Cancer Society, Cancer Screening Guidelines 2008. at: http://www.cancer.org/docroot/ped/content/ped_2_3x_acs_cancer_detection_guidelines_36.asp
American Urological Association (AUA). Prostate-specific antigen (PSA) best practice policy. Oncology 2000;14:267–272, 277–278, 280 passim.
Andriole GL, Grubb RL, Buys SS, Chia D, Church TR, Fouad MN et al. Mortality results from a randomized prostate-cancer screening trial. New Eng J Med 2009; 360: 1310–1319.
Andriole GL, Crawford ED, Grubb RL, Buys SS, Chia D, Church TR, et al. Prostate Cancer Screening in the Randomized Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial: Mortality Results after 13 Years of Follow-up. J Natl Cancer Inst 2012;104:1–8.
Barry M. Screening for prostate cancer – the controversy that refuses to die. New Eng J Med 2009; 360: 1351–1354.
Canadian Cancer Society/National Cancer Institute of Canada: Canadian Cancer Statistics 2006, Toronto, Canada, 2006.
Chou R, LeFevre ML. Prostate Cancer Screening-The Evidence, the Recommendations, and the Clinical Implications. JAMA 2011; 306: 2721–2722.
Crawford ED, Pinsky PF, Chia D, Kramer BS, Fagerstrom RM, Andriole G, et al. Prostate specific antigen changes as related to the initial prostate specific antigen: data from the prostate, lung, colorectal and ovarian cancer screening trial. J Urol. 2006; 175:1286–1290.
Crawford ED, Grubb RL, Black A, Andriole GL, Chen M-H, Izmirlian G et al. Comorbidity and Mortality Results from a Randomized Prostate Cancer Screening Trial. J Cin Oncol. 2011; 29:355–361.
Draisma G, Boer R, Otto SJ, van der Cruijsen IW, Damhuis RAM, Schröder FH et al. Lead Times and Overdetection Due to Prostate-Specific Antigen Screening: Estimates From the European Randomized Study of Screening for Prostate Cancer. J Natl Cancer Inst 2003; 95:868–878.
Frankel S, Smith GD, Donovan J, Neal D. Screening for prostate cancer. Lancet 2003; 361:1122–1128.
Grubb RL, Pinsky PF, Greenlee RT, Izmirlian G, Miller AB, Hickey TP et al. Prostate cancer screening in the Prostate, Lung, Colorectal and Ovarian cancer screening trial: update on findings from the initial four rounds of screening in a randomized trial. BJU International 2008; 102: 1524–1530.
Hugosson J, Carlsson S, Aus G, Bergdahl S, Khatami A, Lodding P, et al. Mortality results from the Göteborg randomized population-based prostate-cancer screening trial. Lancet Oncol. 2010; 11:725–732.
Kilpeläinen TP, Tammela TLJ, Määttänen L, Kujala P, Stenman U-H, Ala-Opas M et al. False-positive screening results in the Finnish prostate cancer screening trial. Br J Cancer 2010; 102: 469–474.
Miller AB. Commentary: Implications of the frequent occurrence of occult carcinoma of the prostate. Int J Epidemiol 2007; 36: 282–284.
Miller AB. New data on prostate cancer mortality after PSA screening N Engl J Med 2012a;366:1047–1048.
Miller AB. Chapter 12. Prostate Cancer Screening. In Cancer and Aging: Research and Practice. Bellizzi K, Gosney M, Eds. New York: Wiley-Blackwell. In press, 2012 b.
Raffle AE, Gray JAM. Screening: Evidence and Practice. Oxford, Oxford University Press, 2007, pp 366.
Sandblom G, Varenhorst E, Rosell J, Lo¨fman O, Carlsson P. Randomised prostate cancer screening trial: 20year follow-up. BMJ 2011; 342:d1539 doi:10.1136/bmj.d1539
Schröder FH. Screening for prostate cancer (PC) – an update on recent findings of the European Randomized Study of Screening for Prostate Cancer (ERSPC). Eur Oncol 2008; 26:533–541.
Schröder FH, Hugosson J, Roobol MJ, Tammela TLJ, Ciatto S, Nelen V et al. Screening and prostate-cancer mortality in a randomized European study. New Engl J Med 2009; 360: 1320–1328.
Schröder FH, Hugosson J, Roobol MJ, Tammela TLJ, Ciatto S, Nelen V et al. Prostate Cancer Mortality at 11 years of Follow-up in the ERSPC. N Engl J Med 2012; 366:981–990.
Schröder FH, Roobol MJ. A comment on prostate cancer screening in the Prostate, Lung, Colorectal and Ovarian cancer screening trial: update on findings from the initial four rounds of screening in a randomized trial. BJU Int 2009; 103: 143–144.
van Leeuwen PJ, van Vugt HA, Bangma CH. The implementation of screening for prostate cancer. Prostate Cancer and Prostatic Diseases 2010; 13: 218–227.
Wolters T, Roobol MJ, Steyerberg EW, van den Bergh RCN, Bangma CH, Hugosson J, et al. The effect of study arm on prostate cancer treatment in a large screening trial (ERSPC). Int J Cancer 2010; 126: 2387–2393.
US Preventive Task Force. Screening for prostate cancer: U.S. Preventive Services Task Force recommendation statement. Annals of Int Med 2008;149:185–191.
Acknowledgements
The initial version of the manuscript that formed the basis for this chapter was jointly written by the present author together with emeritus professor of family medicine of Queen’s University, Ontario, Canada, Walter Rosser, subsequently published as Miller (2012b). Since then, the publications of Andriole et al. (2012) and Schröder et al. (2012) have appeared, and the manuscript was extensively revised for the present chapter.
I should like to express my indebtedness to my colleagues in the PLCO trial, especially Barry Kramer, Paul Pinsky, and Philip Prorok, for many useful discussions on the issues considered in this chapter.
Potential Conflicts of Interest
The author declares that he has no financial relationship with any commercial organization concerned with prostate cancer screening. However, he has been a consultant to the Division of Cancer Prevention of the US National Cancer Institute since 1996, was chair of the Death Review Committee of the PLCO trial 1998–2004, has been chair of the Analysis Cost-effectiveness and Modeling Committee of the PLCO trial since 2004, and is coauthor of a number of publications on the PLCO trial (including Grubb et al. 2008; Andriole et al. 2009, 2012).
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Miller, A.B. (2013). Prostate Cancer Screening. In: Miller, A. (eds) Epidemiologic Studies in Cancer Prevention and Screening. Statistics for Biology and Health, vol 79. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-5586-8_18
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DOI: https://doi.org/10.1007/978-1-4614-5586-8_18
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