US expert panel again recommends PSA test for early detection

Up to now, experts in the USA had expressly spoken out against a widespread use of the PSA test for the early detection of prostate cancer. Their negative judgment about its benefits has the US. The Preventive Services Task Force (USPSTF) has since been revised. Reasons for the 180-degree turnaround are new study results, which show a clear decrease in mortality and metastasis in PSA-tested men, as well as a reassessment of the American PSA study (PLCO).

Experts in the USA criticized the PSA test mainly because of an American study involving more than 75,000 patients, which was published in the New England Journal of Medicine in 2012. After that, there was no difference in the risk of dying from prostate cancer between men who had a test for the prostate specific antigen (PSA) in the blood and those who did not. However, a recent analysis of the study1 revealed major methodological shortcomings. In retrospect, for example, it was found that 90 percent of the allegedly untested men had secretly tested themselves and, if necessary, were also treated.

Survival benefit and lower risk of metastasis

In addition, an updated evaluation of the European study (ERSPC study)2 published for the first time in 2009 has prompted the US expert panel to reassess the significance of the PSA test in the early detection of prostate cancer. Thereafter, the regular review of PSA levels leads to fewer metastases and reduces mortality from prostate cancer. The study shows that prostate cancer mortality can be reduced by around 20 percent in 13 years through PSA screening.

A clear proof of the benefits of the PSA test in prostate cancer screening,"says Dr. Stephan Neubauer from the West German Prostate Center in Cologne. However, according to the urologist, the correct handling of the test results is essential for further action. It happens again and again that PSA values are misinterpreted and acted prematurely. For example, benign prostate enlargement or inflammation can lead to increased but harmless PSA values. Essentially important is always an expertly-founded evaluation of a man's overall findings and not an isolated evaluation of only the PSA,"summarizes Dr. Neubauer.

Literature:

Shoag JE1, Mittal S1, Hu JC2, Reevaluating PSA Testing Rates in the PLCO Trial. N Engl J Med. 2016 May 5;374 (18): 1795-6. doi: 10.1056/NEJMc151515131.
Schröder FH et al.: Screening and prostate-cancer mortality in a randomized Euro-pean study. N Engl J Med. 2009 Mar 26;360 (13): 1320-8 Epub 2009 Mar 18.

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