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New doubts on prostate screening

Friday September 25th, 2009

New research has come out against population-wide screening of men for prostate cancer using the prostate specific antigen test.

Experts, writing today on the website of the British Medical Journal, say there is insufficient evidence that routine screening would be beneficial overall.

Dr Mattias Johansson of the International Agency for Research on Cancer in Lyon, France, and colleagues examined whether the test is suitable for widespread screening. They took figures from 540 patients and 1,034 healthy men to see if their prostate specific antigen levels (taken about seven years before diagnosis) were a good predictor of future cancer.

They report: "No cut-off value for prostate specific antigen concentration attained likelihood ratios required for a screening test." In other words, the test could not distinguish between lethal and harmless prostate cancer, so may lead to overdiagnosis and overtreatment.

However, concentrations below 1.0ng/ml "virtually ruled out a subsequent diagnosis of prostate cancer".

Additional biomarkers for early detection are needed, before routine screening is introduced, the team concludes.

A further article, by Dr Jennifer Stark of Harvard School of Public Health, Boston, USA, and colleagues, states that screening remains controversial and recent results are unlikely to help.

They reviewed the evidence for screening, and concluded that the costs and benefits "remain insufficient to support population based screening". "The financial and psychological costs of false positive results, overdiagnosis, and overtreatment of prostate cancer need to be measured more precisely," they add.

Finally, researchers from Monash University, Australia, agree that further research is needed to "develop and evaluate a screening test that could discriminate between high and low grade prostate cancer and can be implemented in a wider population".

Holmstro, B. et al. Prostate specific antigen for early detection of prostate cancer: longitudinal study. The British Medical Journal, 2009;339:b3537.

Stark, J. R. Screening for prostate cancer remains controversial. The British Medical Journal, 2009;339:b3601.

Ilic, D. and Green, S. Prostate specific antigen for detecting early prostate cancer. The British Medical Journal, 2009;339:b3572.

Tags: North America | Asia | Australia | Cancer | Europe | Menís Health

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