Efficacy Of Prostate-specific Antigen Screening Research Articles

Screening for prostate cancer: History, evidence, controversies and future perspectives toward individualized screening.

Differences in the incidence and mortality rate of prostate cancer between the USA and Japan have been decreasing over time, and were only twofold in 2017. Therefore, countermeasures against prostate cancer could be very important not only in Western countries, but also in developed Asian countries. Screening for prostate cancer in the general population using transrectal ultrasonography, digital rectal examination and/or prostate acid phosphatase began in Japan in the early 1980s, and screening with prostate-specific antigen and digital rectal examination has been widespread in the USA since the late 1980s. Large- and mid-scale randomized controlled trials on screening for prostate cancer began around 1990 in the USA, Canada and Europe. However, most of these studies failed as randomized controlled trials because of high contamination in the control arm, low compliance in the screening arm or insufficient screening setting about screening frequency and/or biopsy indication. The best available level1 evidence is data from the European Randomized Study of Screening for Prostate Cancer and the Göteborg screening study. However, several non-urological organizations and lay media around the world have mischaracterized the efficacy of prostate-specific antigen screening. To avoid long-term confusion about screening for prostate cancer, leading professional urological organizations, including the Japanese Urological Association, are moving toward the establishment of an optimal screening system that minimizes the drawbacks of overdetection, overtreatment and loss of quality of life due to treatment, and maximizes reductions in the risk of death as a result of prostate cancer and the development of metastatic prostate cancer.

The efficacy of prostate‐specific antigen screening: Impact of key components in the ERSPC and PLCO trials

The European Randomized Study of Screening for Prostate Cancer (ERSPC) demonstrated that prostate-specific antigen (PSA) screening significantly reduced prostate cancer mortality (rate ratio, 0.79; 95% confidence interval, 0.69-0.91). The US Prostate, Lung, Colorectal, and Ovarian (PLCO) trial indicated no such reduction but had a wide 95% CI (rate ratio for prostate cancer mortality, 1.09; 95% CI, 0.87-1.36). Standard meta-analyses are unable to account for key differences between the trials that can impact the estimated effects of screening and the trials' point estimates. The authors calibrated 2 microsimulation models to individual-level incidence and mortality data from 238,936 men participating in the ERSPC and PLCO trials. A cure parameter for the underlying efficacy of screening was estimated by the models separately for each trial. The authors changed step-by-step major known differences in trial settings, including enrollment and attendance patterns, screening intervals, PSA thresholds, biopsy receipt, control arm contamination, and primary treatment, to reflect a more ideal protocol situation and differences between the trials. Using the cure parameter estimated for the ERSPC, the models projected 19% to 21% and 6% to 8%, respectively, prostate cancer mortality reductions in the ERSPC and PLCO settings. Using this cure parameter, the models projected a reduction of 37% to 43% under annual screening with 100% attendance and biopsy compliance and no contamination. The cure parameter estimated for the PLCO trial was 0. The observed cancer mortality reduction in screening trials appears to be highly sensitive to trial protocol and practice settings. Accounting for these differences, the efficacy of PSA screening in the PLCO setting is not necessarily inconsistent with ERSPC results. Cancer 2018;124:1197-206. © 2017 American Cancer Society.

Prostate-specific antigen screening: A critical review of current research and guidelines

Screening for prostate cancer (adenocarcinoma of the prostate), using the prostate-specific antigen (PSA) test is controversial among health professionals and organizations who publish screening guideline recommendations for healthcare professionals. Controversy stems from conflicting research studies regarding the efficacy of PSA screening with regard to improved survival rates. This article serves as a critical review of the current guidelines and research to determine which screening practices may be most beneficial to utilize with patients. Literature review of evidence for and against using the PSA test as a screening tool published from 2007 to 2012. Some earlier evidence is currently used to support the guideline recommendations published by professional organizations that recommend against routine screening of asymptomatic men. However, the majority of the latest research demonstrates consistent results showing a reduction in mortality associated with PSA screening. Initiating screening at age 40, to obtain a baseline value, is recommended for primary care providers and is supported by the most recent evidence.

"Screening" for prostate cancer in New York's skid row: history and implications.

The Bowery series, open perineal biopsies performed on more than 1200 alcoholic men recruited from homeless shelters in New York City's Bowery section, began in 1951 and persisted for more than a decade. If frozen sections revealed prostate cancer, men typically underwent radical perineal prostatectomy, orchiectomy, and diethylstilbestrol treatment. This poorly informed, vulnerable population was subjected to health risks that investigators knew others would not accept. Although the knowledge produced had little impact on practice, the Bowery practices foreshadowed and have troubling continuities with later developments. Currently, more than a million American men each year undergo prostatic biopsies. But the efficacy of prostate-specific antigen screening and the treatment that typically follows has never been established. The Bowery series and subsequent developments are part of one continuous story of how medical and lay people came to believe in the efficacy of population screening followed by aggressive treatment without solid supporting scientific evidence.

Früherkennung von Prostatakrebs mittels PSA-Test: Ergebnisse aus einer qualitativen Studie zu arztseitigen Barrieren bei der Umsetzung der informierten Entscheidungsfindung in Österreich

In the context of the Austrian Periodic Health Examination and on the basis of current evidence based medicine a systematic screening for prostate-specific antigen (PSA) is inadvisable. General practitioners (GPs) are expected to inform their patients about risks and benefits of screening before undergoing a PSA test. Ideally, this information corresponds to the model of informed decision making (IDM).The aim of this qualitative pilot-study is to explore factors, which gain insight into GPs' practice of counselling about the PSA test. This qualitative pilot study involves 5 focus groups with 30 GPs and 4 internists and in-depth interviews with 8 GPs. Both the discussions and the interviews were audio-taped, transcribed verbatim, and qualitatively analysed. Data were analysed by using typological analysis and qualitative content analysis as methodological approaches and by means of the software MAXqda. The results of the in-depth interviews show 2 groups of GPs which can be classified by frequency of performing a PSA test: (i) routine screeners, who recommend PSA testing to all patients of 50 years and older, and (ii) non-routine screeners, who inform the patients only if they formally wish it. In-depth interviews as well as focus groups reveal that risks and adverse effects are rarely reported in GP counselling. More often they discuss the potential benefit of the testing. They regard balanced information as unacceptable for both the GP and the patient. Influencing factors concerning the patient (cognitive and emotional demand, preference of the authoritarian doctor, discouraging), factors concerning the GP (own belief in the efficacy of PSA screening, lack of knowledge) and structural factors (lack of time, lack of remuneration) were detected. The results indicate a selective presentation of aspects of screening for prostate cancer within the GP practice of counselling, which seem to overvalue the benefits of the screening and undervalue the associated risks of the PSA test. It should be made clear that the aim - the implementation of informed decision making (IDM) within the context of counselling about PSA test - within the Austrian Periodic Health Examination has not yet been put into practice. Results show that it is necessary to improve GPs' practice of communication, for example, by integrating IDM into the context of GPs' continuous training.

Prostate-Specific Antigen Screening in the United States vs in the European Randomized Study of Screening for Prostate Cancer–Rotterdam

Dissemination of prostate-specific antigen (PSA) testing in the United States coincided with an increasing incidence of prostate cancer, a shift to earlier stage disease at diagnosis, and decreasing prostate cancer mortality. We compared PSA screening performance with respect to prostate cancer detection in the US population vs in the Rotterdam section of the European Randomized Study of Screening for Prostate Cancer (ERSPC–Rotterdam). We developed a simulation model for prostate cancer and PSA screening for ERSPC–Rotterdam. This model was then adapted to the US population by replacing demography parameters with US-specific ones and the screening protocol with the frequency of PSA tests in the US population. We assumed that the natural progression of prostate cancer and the sensitivity of a PSA test followed by a biopsy were the same in the United States as in ERSPC–Rotterdam. The predicted prostate cancer incidence peak in the United States was then substantially higher than the observed prostate cancer incidence peak (13.3 vs 8.1 cases per 1000 man-years). However, the actual observed incidence was reproduced by assuming a substantially lower PSA test sensitivity in the United States than in ERSPC–Rotterdam. For example, for nonpalpable local- or regional-stage cancers (ie, stage T1M0), the estimates of PSA test sensitivity were 0.26 in the United States vs 0.94 in ERSPC–Rotterdam. We conclude that the efficacy of PSA screening in detecting prostate cancer was lower in the United States than in ERSPC–Rotterdam.

Recent trends in prostate cancer mortality show a continuous decrease in several countries

Prostate specific antigen (PSA) screening was introduced to detect prostate cancer at an early stage and to reduce prostate cancer-specific mortality. Until results from clinical trials are available, the efficacy of PSA screening in reducing prostate cancer mortality can be estimated by surveillance of prostate cancer mortality trends. Our study analyzes recent trends in prostate cancer mortality in 38 countries. We used the IARC-WHO cancer mortality database and performed joinpoint analysis to examine prostate cancer mortality trends and identified 3 patterns. In USA, and to a lesser extent in Germany, Switzerland, Canada, France, Italy and Spain, prostate cancer-specific mortality decreased to a level lower than before the introduction of PSA screening. In Australia, New Zealand, Austria, Finland, The Netherlands, Norway, United Kingdom, Hungary, Slovakia, Israel, Singapore, Sweden and Portugal, mortality from prostate cancer decreased but rates remain higher than before the introduction of PSA screening. Prostate cancer mortality continued to increase in Belgium, Denmark, Greece, Ireland, Bulgaria, Czech Republic, Belarus, Ukraine, Russian Federation, Romania, Poland, Argentina, Chile, Cuba, Mexico, Japan, China Hong Kong and the Republic of Korea. The trends in prostate cancer mortality rates in examined countries suggest that PSA screening may be effective in reducing mortality from prostate cancer.