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).
AdvertisementThe 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 medication side-effects.
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.
Reference: Quality-of-Life Effects of Prostate-Specific Antigen Screening; Eveline Heijnsdijk et al; N Engl J Med 2012; 367:595-605