A new study run by the American Society of Clinical Oncology has shown a profound effect that prostate cancer screening has had on death rates. The European Randomized study of Screening for Prostate Cancer (ERSPC) began in the early 90s. The study was the first to test the effects of prostate-specific antigen (PSA)-based screening on prostate cancer mortality in a large population. The study contradicted more than two decades of research and calculated the effects in over 160,000 men across 7 European countries. It gave essential information about the danger associated with missing film screenings.
The ERSPC study was designed to evaluate the risk of dying from prostate cancer. It targeted people who were provided with an invitation to screening, but chose not to come. Our findings tell a story of alarming neglect. For example, men who declined screening have a 39% increased risk of dying from prostate cancer than men who were never offered screening. This vital discovery alludes to the deadly effects of choosing to opt out of PSA screenings.
Principal investigator Renée Leenen, MD, PhD candidate at the Erasmus MC Cancer Institute. She noted too that a web of social determinants of health typically drives the choice to forgo screening. This was a large study, with 72,460 men randomized to the screening arm. From these, 12,401 men (17%) had never attended any of the recommended screening cycles.
“Of the 72,460 men randomized to the screening arm, 12,401 (17%) did not attend any of the screening rounds offered,” – Renée Leenen, MD.
The numbers are shocking. Men who attended no screenings at all—12,401 men—were almost 40% more likely to die from prostate cancer. What makes these findings especially relevant. Together, they lay the groundwork for the ERSPC—the world’s largest prostate cancer screening study to date.
These findings underscore the importance of reexamining the prostate cancer screening landscape in the US. Here’s a closer look at the approach and what it means going forward. In the past, PSA screening has been very controversial, which is understandable given that PSA screening has risks related to overtreatment. With regard to prostate cancer, between 2012 and 2017 USPSTF recommended against PSA-based screening. They warned of the potential harms associated with overdiagnosis and overtreatment. This was a time when screening rates fell considerably, leading to later stage diagnoses of prostate cancer.
Ramkishen Narayanan, MD, a board-certified urologist and urologic oncologist, spoke to the significance of the ERSPC study. He noted its far-reaching impact on U.S. efforts to conduct screening nationwide. In doing so, he observed that the results expose a high-risk group that has long been ignored. He urged that failing to test for prostate cancer significantly increases a man’s chance of dying from the disease.
“Prostate cancer screening trials and population-based screening programs/events were utilized in the U.S. in the past but fell out of favor due to the undisciplined management of results and subsequent treatment. In the contemporary era… this study sends a clear signal through the noise — ignoring prostate cancer screening will significantly increase a man’s risk of dying from prostate cancer,” – Ramkishen Narayanan, MD.
With the ERSPC study, we’ve learned that participating in prostate cancer screenings can dramatically reduce your risk of dying from the disease. In reality, that’s actually a 23% reduction for those who participate. This shocking statistic goes against everything we’ve been told for decades about the value of PSA screenings.
“There has long been controversy over whether PSA screening is helpful in a disease that we’ve long labeled as ‘one that most patients will die with, rather than die from,’ but this study seems to suggest a 23% decrease in mortality specifically from prostate cancer in men who engage in screening,” – Nilesh Vora, MD.
Even while acknowledging the promising findings, Narayanan raised important questions. He highlighted the need for more clarity on how to apply PSA screening most effectively to the typical patient. Now the urologic community in the United States is adopting a shared decision-making pathway. This new approach gives patients the power to decide when they want to start or stop PSA screenings, with the involvement and guidance of their physicians.
“What is still left up to interpretation is the best practical application of PSA screening for the average man. The urologic community in the United States has adopted a shared decision-making pathway with patients about prostate cancer screening,” – Ramkishen Narayanan, MD.
This joint study has deep implications. Further, it highlights the urgent need to raise public awareness and understanding around prostate cancer screenings. Narayanan pointed out a potential pitfall of over-correcting or trying to discourage screenings because of concerns about overtreatment. The effect of this was that, as screening rates decreased, more advanced and aggressive cases started to emerge.
“The concern over potentially unnecessary surgery or radiation led to an over-correction where prostate cancer screening was discouraged in the U.S. from 2012 to 2017 by the United States Preventive Services Task Force (USPSTF). We know that the reduction in prostate cancer screening during that time period led to prostate cancer getting diagnosed at higher grades and stages,” – Ramkishen Narayanan, MD.
Leave a Reply