PSA test cuts mortality rate in half

Despite of the success since the implementation of PSA testing became a routing at the beginning of the 1980s, the test for early detection of the prostate cancer is now even more critically discussed than ever before. The recent discussions were caused by two American studies that were published last year by the “New England Journal of Medicine”. While the European studies evidenced that the mortality rate for men, whose blood was examined for prostate cancer specific anti-gene (PSA), decreased by 20 per cent, the American study could not find a significant difference between tested and untested men.

A third study published recently in the periodical “Lancet-Oncology, now showed that the PSA test was attacked unreasonably. Swedish medicals at the University of Goteborg have investigated the benefits of the PSA test by examining 20,000 men in the age of 50 to 65 years, whose progression of the disease had been documented in the course of 14 years. Half of the participants in the study were invited to undergo a PSA test every two years. In case of an abnormal finding, the patients underwent a biopsy.

A PSA test can save lives
The results are clear: collectives with 0.9% (no PSA Test) versus 0.5% (PSA test) a significant reduction of the mortality could be evidenced. In contrast to the comparative group, after 14 years only 50% of the men in the PSA group died due to a carcinoma in the prostate gland. “The Swedish study clearly shows that a PSA screening does indeed save lives” says Dr. Derakhshani, Urologist at the West German Prostate Cancer Center Cologne. Whether the low mortality rate also has an effect on the total survival rate of the men, cannot clearly be determined at this time. To see what kind of changes appear over time, a longer follow-up is necessary, says Dr. Derakhshani.

Minimizing the side effects of the treatment
“Just about 300 men must be invited for an early detection exam and in 12 men prostate cancer must be found, in order to prevent death as a cause of the disease”, reports Dr. Neal, Director of Studies. Although there is still the danger of an overdiagnosis, which means that tumors are discovered that are not life threatening. However, these cases are considerably lower than in earlier studies. Consequently the number of the so-called “Number Needed to Treat” are comparatively equal with the conventional procedures for early detection of breast cancer

Besides, not every men who is diagnosed with prostate cancer has to undergo radical prostatectomy (complete removal of the prostate), continues Dr. Neal. For prostate cancer patients, the focus should be rather on achieving an optimal survival rates with minimal side effects. Modern radiotherapy methods, like brachytherapy, are here best suitable. In contrast to the radical prostatectomy, in brachytherapy the prostate gland is preserved. With the ultra sound controlled placement of radioactive seeds directly into the prostate gland, the tumor is selectively targeted and destroyed without harming the surrounding tissue. In some cases, it is even sufficient to watch the cancer and to control it effectively (active monitoring).

Neal DE.: PSA testing for prostate cancer improves survival-but can we do better? Lancet Oncol. 2010 Jun 30.