Gerald L. Andriole, MD
Annual prostate cancer screening does not decrease mortality from prostate cancer more than opportunistic screening, according to updated results from the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial.
Gerald L. Andriole, MD, chief of the Division of Urologic Surgery at Washington University School of Medicine in St. Louis, Missouri, and colleagues elsewhere randomized 76,685 men aged 55-74 years to undergo either annual serum prostate-specific antigen (PSA) testing for 6 years and annual digital rectal examination (DRE) for 4 years or usual care, in which case the men sometimes underwent opportunistic screening.
The investigators previously reported that there was no benefit of prostate cancer screening after 7 to 10 years of follow-up.
The updated analysis reveals no indication of a reduction in prostate cancer mortality with organized annual screening after 13 years of follow-up.
“The data confirm that for most men, it is not necessary to be screened annually for prostate cancer,” Andriole said in a news release.
He advised against mass screening predicated solely on age, and instead called for a “more nuanced approach” aimed at identifying which men should undergo PSA screening and how often they should be screened. In addition, it would be aimed at determining the PSA level that signals the need for a biopsy and whether the cancer requires aggressive treatment.
In the study, roughly 92% of the trial participants were followed to 10 years and 57% to 13 years. At 13 years, 4250 men in the intervention arm versus 3815 in the control arm had been diagnosed with prostate cancer. There was a 12% relative increase in the incidence of prostate cancer (relative risk = 1.12; 95% CI, 1.07-1.17) and a nonstatistically significant decrease in the high incidence of high-grade prostate cancer in the intervention arm.
Moreover, there was no evidence of a prostate cancer mortality interaction of treatment assignment with age, baseline comorbidity, and pretrial PSA testing.
Andriole and colleagues noted that while their findings to date show no benefit of “adding an organized component of annual screening to the opportunistic screening already in place,” there is evidence of harm with such a practice. The harm is partly accounted for by false-positive tests and is also associated with “the overdiagnosis inseparable from PSA screening, especially in older men.”
The researchers said that they intend to update the mortality results from the prostate component of the PLCO study as soon as follow-up data through to 15 years are available.
Andriole GL, Crawford ED, Grubb RL III, et al. Prostate cancer screening in the randomized Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial: mortality results after 13 years of follow-up [published online ahead of print January 6, 2012]. J Natl Cancer Inst. doi: 10:1093/jnci/djr500.