PSA Screening After Publication of the Large Screening Trials

Results of the U.S. and European randomized trials of prostate-specific antigen (PSA) screening were published in March 2009 (JW Gen Med Mar 18 2009). The U.S. study, which showed no benefit for screening, was considered to be flawed because many control participants underwent PSA testing; the European study showed a small absolute reduction in prostate cancer-specific mortality in the screened group, but overdiagnosis and overtreatment were considerable.

Seven countries participated in the European trial, and Finland contributed about half of the 160,000 men in the core age group (age range, 55–69). A new report describes the Finnish results. After median follow-up of 12 years, prostate cancer-specific mortality was lower — but not significantly so — in the screening group than in the control group (0.47% vs. 0.55%; P=0.1). All-cause mortality was identical in the two groups. For every prostate cancer–related death averted, about 1200 people were screened and about 25 cancers were diagnosed. Finnish outcomes were similar to those of the trial overall.

To determine whether the European and U.S. trials changed practice, U.S. researchers used a commercial insurance database (covering 1.5 million men annually) to track PSA testing from 2001 through 2011. Screening rates in 2010 and 2011 were similar to rates during the several years before 2009.