Prostate cancer screening using prostate-specific antigen (PSA) started around 1987 in the United States and has profoundly changed the epidemiology of prostate cancer, with a rapid doubling of incidence and, by 2015, a 50% decrease in annual prostate cancer mortality.
There is still uncertainty regarding how much PSA screening is responsible for declining mortality rates as well as how the benefits of screening measure up to the harms of finding and treating cancers that never would have caused morbidity or mortality.
In a recently published study, researchers from Weill Cornell Medicine, Fred Hutchinson Cancer Center, University Hospitals Cleveland, and Case Western Reserve University found that prostate cancer screening with the PSA blood test has remarkably favorable benefits. The study appears in the journal NEJM Evidence.
The team estimated 1.5 to 1.9 million overdiagnosed and 0.9 to 1.5 million overtreated prostate cancers by 2016. Assuming that half of the 270,000 prostate cancer deaths avoided by 2016 were attributable to screening. The team also calculated the mortality benefit, using numbers needed to diagnose (NND) and treat (NNT) to prevent one prostate cancer death.
The investigators estimated that for men of all races one death was prevented for every 11 to 14 men diagnosed with prostate cancer and every 7 to 11 men treated for the disease.
In the case of black men, screening resulted in one death prevented for every 8 to 12 men diagnosed, and every 5 to 9 men treated.
The results highlighted the benefit and support of PSA screening, and that it should continue to be a routine test as recommended in current guidelines.
Spyridon P. Basourakos, et al. Harm-to-Benefit of Three Decades of Prostate Cancer Screening in Black Men. 2022. DOI:https://doi.org/10.1056/EVIDoa2200031