Prostate cancer screening could cut deaths by 20%, study argues

Doubts over whether benefits of testing outweigh harm done, says the ‘Lancet’

Screening for prostate cancer could reduce deaths from the disease by about a fifth, according to a major European study published today in The Lancet.

However, routine screening programmes for the disease should not be introduced at this time because of doubts as to whether the benefits of testing outweigh the harm done, the authors of the study conclude.

PSA (prostate-specific antigen) testing delivers a substantial reduction in prostate cancer deaths, similar to that reported in screening for breast cancer. However, over-diagnosis occurs in about 40 per cent of cases, resulting in a high risk of over-treatment. Severe side-effects can include incontinence and impotence.

The Irish National Cancer Control Programme (NCCP) said it agreed with the recommendation of the study against population-based screening.

“We do recommend that men get the best possible information about the appropriateness of a test, and if they are symptomatic – for example, if they have difficulty urinating – they should get one,” said NCCP director Dr Susan O’Keeffe.

Randomised study

The European Randomised study of Screening for Prostate Cancer began in 1993 to determine whether screening men for PSA reduces deaths from prostate cancer. It recruited more than 162,000 men between the ages of 50 and 74 from eight continental European countries.

Results showed that screening appeared to reduce prostate cancer deaths by 15 per cent after nine years, improving to 22 per cent after 11 years.

"The time for population-based screening has not arrived," said study leader Prof Fritz Schröder from Erasmus University Medical Centre in the Netherlands. "Further research is urgently needed on ways to reduce over-diagnosis preferably by avoiding unnecessary biopsy procedures, and reducing the very large number of men who must be screened, biopsied and treated to help only a few patients."

With more than 3,200 cases a year, prostate cancer accounts for 21 per cent of diagnosed cancers in Irish men. The disease is as common among men as breast cancer is among women.