Breaking News
March 21, 2018 - Insurance Company Hurdles Burden Doctors, May Harm Patients
March 21, 2018 - Renal Transplant from HCV-Positive Donors Feasible
March 21, 2018 - Myelodysplastic syndrome: MedlinePlus Medical Encyclopedia
March 21, 2018 - Research reveals brain mechanism involved in language learning
March 21, 2018 - Many parents still hesitate to try early peanut introduction, survey finds
March 21, 2018 - Audiologist urges tinnitus sufferers facing ‘revolving door healthcare’ to seek support
March 21, 2018 - Study reveals impact of prostate cancer on wives and partners of sufferers
March 21, 2018 - ‘Almost a Miracle Drug’: What We Heard This Week
March 21, 2018 - Study shows NIH spent >$100 billion on basic science for new medicines
March 21, 2018 - Columbia researchers identify nerve cells that drive fruit fly’s escape behavior
March 21, 2018 - Sartorius Stedim Biotech selected by ABL Europe to supply single-use process technologies
March 21, 2018 - Increase in coffee consumption may help battle against colon cancer
March 21, 2018 - Hydrogel may accelerate healing of diabetic ulcers
March 21, 2018 - Dermira’s Two Phase 3 Trials Evaluating Olumacostat Glasaretil in Patients with Acne Vulgaris Did Not Meet Co-Primary Endpoints
March 21, 2018 - DePuy Synthes introduces ACTIS Total Hip System for improving initial implant stability
March 21, 2018 - ‘Oh, It Was Nothing’
March 21, 2018 - Herbal drug kratom linked to salmonella illnesses, CDC says
March 21, 2018 - New optical point-of-care device could enhance screening for thyroid nodules
March 21, 2018 - FDA Expands Approval of Adcetris (brentuximab vedotin) for First-Line Treatment of Stage III or IV Classical Hodgkin Lymphoma in Combination with Chemotherapy
March 21, 2018 - Eosinophilic Esophagitis: Late Manifestation of Allergic March
March 21, 2018 - Signaling pathway involving the Golgi apparatus identified in cells with Huntington’s disease
March 21, 2018 - Quintupling inhaled steroid doses may not benefit children with asthma
March 21, 2018 - Study shows clear connection between cardiovascular fitness in middle age and dementia risk
March 21, 2018 - Premature babies have higher risks of health complications in Bangladesh
March 21, 2018 - Child’s temperament and parenting influence weight gain in babies
March 21, 2018 - Researchers find the heart to be capable of arrhythmia termination after local gene therapy
March 21, 2018 - Inhealthcare to provide digital infrastructure for NHS to help protect people from falls
March 21, 2018 - Flu Season Finally Slowing Down
March 21, 2018 - Mixed Results for Shorter DAPT in ACS Patients
March 21, 2018 - Scientists discover fish scale-derived collagen effective for healing wounds
March 21, 2018 - Genomics England announces new partnership to improve efficiency of next-generation sequencing analysis
March 21, 2018 - Adjuvant AC chemotherapy found to be effective in treating HRD-positive breast cancer patients
March 21, 2018 - Researchers identify new treatment targets for lung diseases using big data
March 21, 2018 - Kids see more women in science than five decades ago
March 21, 2018 - Research shows link between chronic fatigue syndrome and lower thyroid hormone levels
March 21, 2018 - Alzheimer’s disease on the rise
March 21, 2018 - Two Agents Equal as Pretreatment for Adrenal Tumor Surgery
March 21, 2018 - ‘Icebreaker’ protein opens genome for T cell development, researchers find
March 21, 2018 - Women in medicine shout #Metoo about sexual harassment at work
March 21, 2018 - Mother’s pre-pregnancy waist size may be linked to child’s autism risk
March 21, 2018 - Second hand marijuana smoke can cause serious damage
March 21, 2018 - International study shows benefits of using MRI at the start of prostate cancer diagnosis
March 20, 2018 - Santhera Reports Outcome of Exploratory Trial with Idebenone in PPMS Conducted at the NIH
March 20, 2018 - ECG Patch Ups At-Home Afib Diagnosis in mSToPS Trial
March 20, 2018 - ROS-scavenging nanozymes for anti-inflammation therapeutics
March 20, 2018 - Genomics England announces appointment of global genomics pioneer as first CEO
March 20, 2018 - Test flight at German Aerospace Center in Cologne demonstrates functionality of deficopter
March 20, 2018 - Music therapy helps treat combat-related psychological injuries in military personnel
March 20, 2018 - Innovative psychotherapeutic treatment protocol for obsessive-compulsive disorders
March 20, 2018 - Weight loss after lap-band surgery alleviates arthritic knee pain
March 20, 2018 - New diabetes drug may help obese people shed body weight
March 20, 2018 - Novel Peanut OIT a Winner in Phase III Trial
March 20, 2018 - Can gene therapy be harnessed to fight the AIDS virus?
March 20, 2018 - Education and academic achievement can lessen effects of child abuse, neglect
March 20, 2018 - Researchers develop new algorithm to make CPR more effective
March 20, 2018 - Diabetes medication reduces chance of late miscarriage, premature birth among women with PCOS
March 20, 2018 - SSRIs may be more effective option for treating anxious youth, UC research shows
March 20, 2018 - Antibiotics could benefit women suffering from chronic bladder pain
March 20, 2018 - Health Highlights: March 16, 2018
March 20, 2018 - Interventional Radiology Has a Problem of ‘Unseen’ Value
March 20, 2018 - Antibodies show effectiveness for HIV prevention and promise for treatment and cure
March 20, 2018 - New 3-D-printed technology will improve radiology training
March 20, 2018 - New study identifies key role for particular gene in 16p11.2 deletion syndrome
March 20, 2018 - Red and processed meat increase the risk of liver disease
March 20, 2018 - 50% of Australians do not brush teeth twice a day
March 20, 2018 - American Gene Technologies receives second immuno-oncology patent
March 20, 2018 - Study finds no link between long-term violent video game play and adult aggression
March 20, 2018 - Weight loss surgery widely underutilized among young patients with severe obesity
March 20, 2018 - Scientists uncover new answers to cell aging in children with rare, fatal disease
March 20, 2018 - The Pistoia Alliance Calls for Greater Life Sciences Collaboration to Build the ‘Lab of the Future’
March 20, 2018 - Morning Break: Psychopathic Thought; Americans Flout Zzz’s; Farm to Pharma
March 20, 2018 - Perceptions of old age change as we age
March 20, 2018 - New standards for public involvement in research launched across the UK
March 20, 2018 - Whole Genome Sequencing used as diagnostic solution for TB
March 20, 2018 - Researchers show how two cancer genes work together to trigger leukemia
March 20, 2018 - Scientists discover basic molecular mechanism that helps understand how ALS works
March 20, 2018 - Multi-center study to evaluate promising new intervention for upper limb dysfunction after SCI
March 20, 2018 - Researchers develop technology to program DNA for delivering cancer drugs
March 20, 2018 - Northwestern scientists bring precision medicine to rheumatoid arthritis
March 20, 2018 - Research suggests possible link between heading a soccer ball and brain imbalance
Single PSA Test Fails to Reduce Prostate Ca Deaths

Single PSA Test Fails to Reduce Prostate Ca Deaths

image_pdfDownload PDFimage_print

Action Points

  • One-time screening with a prostate-specific antigen (PSA) test failed to reduce prostate cancer deaths at 10 years, according to results of a randomized trial including over 400,000 British men in 573 primary care practices.
  • Recognize that screening for prostate cancer using PSA tests remains controversial, as the potential benefits of disease detection in its early stages can be outweighed by harms from overtreatment.

One-time screening with a prostate-specific antigen (PSA) test failed to reduce prostate cancer deaths at 10 years, despite an uptick in diagnoses of the disease, according to results of a randomized trial that included over 400,000 British men.

During the trial, 549 of 189,386 patients in the screening arm died from prostate cancer (0.30 per 1,000 person-years) compared with 647 of 219,439 patients in the control arm (0.31 per 1,000 person-years) for a rate ratio of 0.96 (P=0.50).

“The Cluster Randomized Trial of PSA Testing for Prostate Cancer (CAP) was designed to determine the effects of a low-intensity, single invitation PSA test,” wrote Richard M. Martin, PhD, of the University of Bristol, England, in JAMA. “Although longer-term follow-up is under way, the findings do not support single PSA testing for population-based screening.”

The trial included 419,582 men ages 50 to 69 screened at 573 primary care practices across the United Kingdom. Patients were recruited beginning in 2001, with follow-up concluding in 2016.

While no reduction in deaths due to prostate cancer were seen among screened patients, more cases of the disease were diagnosed in men receiving a PSA test (4.3%) compared with unscreened patients (3.6%). More tumors with a Gleason score of 6 or lower were identified in the screened group compared with the control group (1.7% versus 1.1%, respectively).

Localized disease (stage T1 or T2 cancer) was diagnosed at a more frequent rate in the screened group (2.6% versus 1.9% in the control group); in turn, fewer cases of advanced-stage cancer were diagnosed in this group (0.5% versus 0.6% in the control group).

Of the 549 men who died of prostate cancer in the screening group, only 188 had visited the clinic for PSA testing. Lethal cancer was diagnosed in 59 of these 188. Of the remaining 129 patients:

  • 68 were ineligible for prostate biopsy due to a PSA level less than 3.0 ng/mL,
  • 42 did not undergo PSA testing despite having attended the clinic,
  • 15 men had a PSA level 3.0 ng/mL or higher yet did not undergo a biopsy,
  • and 4 men had a benign biopsy.

In the all-cause mortality analysis, 25,459 died in the intervention group compared with 28,306 in the control group for a RR of 0.99 (P=0.49).

Screening for prostate cancer using PSA tests remains controversial, as the potential benefits of disease detection in its early stages can be outweighed by harms from overtreatment. In 2012, the U.S. Preventive Services Task Force (USPSTF) recommended against routine PSA screening for men of any age, but in 2017 adjusted this recommendation and now support an individualized approach to screening for men ages 55 to 69.

“It has been hypothesized that screening men in their early 50s may be more effective than at a later age,” the authors wrote. “However, we did not find statistical evidence to support this.”

In terms of adherence to screening, 75,707 patients (40%) of the 189,386 men assigned to the intervention arm attended the clinic for PSA testing; 67,313 of these men underwent PSA testing. High PSA levels — 3.0 ng/mL to 19.9 ng/mL — were detected in 6,857 patients and 5,850 underwent a biopsy.

In an editorial accompanying the article, Michael J. Barry, MD, of Harvard Medical School and Massachusetts General Hospital in Boston, wrote: “A key question is whether the findings from the CAP trial should swing the pendulum further in the direction of not offering screening PSA tests. Based on the CAP results, an offer of a single PSA screen in a population of men aged 50 to 69 years is ineffective, and given the higher risk of a prostate cancer diagnosis this approach engenders, likely does more harm than good.”

Barry, who is a member of the USPSTF, added that while further follow-up from CAP could potentially reveal benefit, based on the evidence so far “that eventuality seems unlikely.”

Martin and co-authors reported no conflicts of interest. Barry is chief science officer at Healthwise, and grants from the company have been awarded to Massachusetts General Hospital.

The CAP trial was funded by grants from Cancer Research U.K., and partial funding was provided by the U.K. Department of Health, National Institute of Health Research.


last updated

Tagged with:

About author

Related Articles