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Invited Commentary
July 2016

Does Prostate-Specific Antigen Screening Do More Good Than Harm?Depends on How You Do It

Author Affiliations
  • 1Memorial Sloan Kettering Cancer Center, New York, New York
JAMA Oncol. 2016;2(7):899-900. doi:10.1001/jamaoncol.2015.6276

Early detection for prostate cancer using the prostate-specific antigen (PSA) test remains controversial. Until relatively recently, this controversy revolved around whether use of the test actually had any effects on prostate cancer mortality. Data emerging over the past few years has laid that question to rest. There have been 2 large randomized clinical trials of PSA screening, the European Randomized Trial of Screening for Prostate Cancer (ERSPC)1 and the US-based Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial.2 The ERSPC reported that PSA screening led to a 20% to 25% reduction in the risk of prostate cancer mortality at 13 years. This is despite the median age at first screening being relatively old, and the treatment offered to men in the trial being somewhat inadequate by contemporary standards.3 Although often cited as a “negative” trial, the US PLCO trial of prostate cancer was subject to severe contamination, with approximately half of the patients in the control group receiving a PSA test during the trial. The authors of the trial themselves do not describe this as a trial of screening, but rather as a comparison between different approaches to screening.2 Hence, the one adequate trial of PSA screening does show that it reduces prostate cancer mortality. This result is complemented by trends showing large decreases in prostate cancer mortality in the US population following the introduction of PSA,4 and data comparing geographical regions in Sweden, demonstrating that changes in incidence, attributed to PSA screening, reliably predict subsequent changes in mortality.5

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