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Routine PSA Screening Does Not Cut Prostate Cancer Deaths

Last Updated: September 15, 2010.

Routine prostate-specific antigen screening does not ultimately reduce prostate cancer deaths, but a single prostate-specific antigen test at age 60 may identify men at higher risk of developing and dying from the disease, according to a pair of studies published online Sept. 14 in BMJ.

WEDNESDAY, Sept. 15 (HealthDay News) -- Routine prostate-specific antigen (PSA) screening does not ultimately reduce prostate cancer deaths, but a single PSA test at age 60 may identify men at higher risk of developing and dying from the disease, according to a pair of studies published online Sept. 14 in BMJ.

Mia Djulbegovic, of the University of Florida in Gainsville, and colleagues conducted a meta-analysis of six studies encompassing 387,286 subjects that assessed the benefit of PSA screening compared to no screening. They found no significant effect of screening on risk for prostate cancer death (relative risk, 0.88) or overall mortality (relative risk, 0.99) compared to no screening. The researchers concluded that current evidence does not support the routine use of PSA tests to screen for prostate cancer.

In a second study, Andrew J. Vickers, Ph.D., of the Memorial Sloan-Kettering Cancer Center in New York City, and colleagues followed 1,167 60-year-old men in Sweden from 1981, when they had PSA counts taken, until age 85. The cohort had 35 deaths from prostate cancer and 43 cases of prostate cancer metastasis. PSA level at age 60 was associated with metastasis and death (areas under the curve, 0.86 and 0.90, respectively), and 90 percent of cancer deaths occurred among men in the top PSA quartile at age 60.

"Though men aged 60 with concentrations below the median (≤1 ng/mL) might harbor prostate cancer, it is unlikely to become life threatening. Such men could be exempted from further screening, which should instead focus on men with higher concentrations," Vickers and colleagues conclude.

One author in the Vickers study holds patents for free PSA and kallikrein related peptidase 2 assays.

Abstract - Djulbegovic
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Abstract - Vickers
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