Evidence of PSA screening efficacy lacking

March 04, 2002

There is no evidence to support speculation that prostate-specific antigen (PSA) screening has contributed to a decline in prostate cancer mortality rates since 1995, a new study has determined. The value of such screening remains controversial. Some American authorities have called for cancer screening in men who ask about the PSA test, while the Canadian Urological Association and most health authorities in Europe still discourage it. The number of men becoming candidates for such screening is growing rapidly because of the aging of the baby-boom generation. Dr. François Meyer and colleagues divided the adult males of Quebec who were 50 years or older into 15 birth cohorts and computed the change in prostate cancer incidence between 1989 and 1993, and the change in prostate cancer mortality between 1995 and 1999. They then assessed the correlation between the changes in cancer incidence and the subsequent changes in prostate cancer mortality. The authors also split the population into 15 regional populations and repeated the analysis, which yielded a similar outcome, leading them to conclude that PSA screening cannot explain the decline in prostate cancer mortality in the population studied. The authors warn that the results need to be considered with caution because PSA screening may well be shown to be an effective tool in preventing or postponing death from prostate cancer, but the evidence does not yet exist to support such a claim.

In a related commentary, André Vis says answers on whether PSA screening is truly beneficial at a population level will only be provided when large-scale randomized controlled trials -- several of which were begun in the US and Europe in the early 1990s -- are completed.
p. 586 PSA screening and prostate cancer mortality
-- F. Meyer et al

p. 600 Does PSA screening reduce prostate cancer mortality?
-- A.N. Vis

Canadian Medical Association Journal

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