Prostate-specific antigen (PSA) testing
is a screening test that assists in early diagnosis of prostate cancer. An
early diagnosis enables early treatment and thereby prevents the spread of
cancer to other organs and death. But there is a flipside to this issue.
Prostate cancer does not always cause symptoms and may take years to progress
in some cases. Thus, subjecting the patient to medications, biopsies and
surgery, especially in an elderly male, could interfere with the quality of
life of the patient.
A recent paper in the New England Journal of Medicine
published results at the 11-year mark of an ongoing study, the European
Randomized Study of Screening for Prostate Cancer (ERSPC).
The study results indicate that PSA
screening, in men aged 55 and 69 years, leads to a 28% decrease in
prostate-cancer-related deaths. In addition, there was a 35% decrease in
patients receiving palliative treatment. Thus, there is no doubt of the benefit
of PSA screening.
On the other hand, PSA screening has
significant negative outcomes. Up to 56% screen-identified tumors, which would
have remained clinically asymptomatic, were often treated and linked to adverse
effects. In the time taken (5 to 12 years) for clinical symptoms to appear, the
patient could have had a better quality of life rather than living with
In terms of quality of life after
prostate-cancer therapy over 6 to 52 months, nearly
88% men who received radical prostatectomy and up to 66% men who received
radiation therapy and were potent earlier, became impotent. In addition, a
number of men experienced incontinence.
The study thus concluded that PSA
screening could affect the quality of life of the patient and thereby result in
reduced benefits. More data is required before official recommendations are
made regarding the use of PSA testing in the screening of prostate cancer.
Effects of Prostate-Specific Antigen Screening; Eveline Heijnsdijk et al; N Engl J Med 2012; 367:595-605