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Prostate cancer: too many adverse effects from PSA-based screening

There is no evidence to support PSA-based testing to screen for prostate cancer, whereas the adverse effects have been demonstrated.

Men with prostate cancer remain asymptomatic for a long time. In elderly patients who have a well differentiated localised cancer, the cancer generally has little or no effect on life expectancy.

Screening for prostate cancer is done by measuring the level of PSA (prostate specific antigen) in the blood, sometimes combined with a rectal examination.

According to clinical trials available at the beginning of 2012, screening has no proven efficacy in reducing prostate cancer mortality.

Around 70% of men with a PSA level considered “positive” do not in fact have prostate cancer. These false positive results worry patients and result in repeated prostate biopsies with frequent adverse effects: blood in sperm (around 50% of cases), blood in the urine (around 20% of cases), acute urine retention, infections, and septicaemia.

30 to 80% of cancers detected by screening would not have compromised the patient’s health had they been ignored. These “overzealous” diagnoses needlessly expose patients to long-term adverse effects of surgery and radiotherapy: urinary incontinence (5 to 25% of patients treated), erectile dysfunction (40 to 80 % of patients treated), and psychological effects. Radiotherapy exposes patients to a risk of bladder and rectal cancer.

As of early 2012, the clinical value of screening for prostate cancer through PSA testing has not been documented. Patients should be informed of the natural outcome of localised prostate cancers and of the adverse effects of screening.

©Prescrire 1 September 2012

"PSA-based screening for prostate cancer. Too many adverse effects" Prescrire Int 2012; 21 (130): 217-219 (Pdf, subscribers only).
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