Should the UK Endorse the PSA Test?

Prostate cancer deaths higher in England where screening lower

(RxWiki News) Major medical organizations no longer recommend regular prostate cancer screening for most men. A new study looked at how lethal prostate cancer is in areas where screenings are low.

After analyzing the causes of death among men with prostate cancer, researchers in England found that about half of the men died of the cancer.

Prostate cancer screening was not common in the area of the UK where the study was conducted.  

These researchers said this study's results challenge the belief that prostate cancer is not a major cause of death.

"If prostate cancer runs in your family, talk to your doctor."

Simon Chowdhury, MD, of Guy’s Hospital in London, UK, directed a study that examined the causes of death among 50,066 prostate cancer patients in the Thames Cancer Registry.

The men were diagnosed with cancer between 1997 and 2006, and were followed until the end of 2007.

“Most studies examine the direct effect of increased detection, etc., on the mortality rate directly. This study, conversely, looked at the negative effects found in an area of Great Britain where there is low to no screening for prostate cancer,” prostate cancer specialist Brian J. Miles, MD, FACS, at Methodist Hospital in Houston, TX, told dailyRx News.

Prostate cancer screening was much lower in the area of UK where the men lived than in the US.

"Screening occurs in up to 50 percent of US males, but only 6 percent of men in this London area," Dr. Miles said. 

“In this area, PSA testing was done only on an ‘opportunistic' basis," Dr. Miles explained. This means only if the attending physician thought it was appropriate," he said.

At the end of the 10-year study period, here’s what the UK researchers found:

  • 20,181 (40.3 percent) men died.
  • 49.8 percent (10,053 men) died of prostate cancer.
  • 17.8 percent of the men died of cardiovascular disease.
  • 11.6 percent died of other cancers.
  • 20.7 percent of the men died of other causes.

According to the 2006-2010 Surveillance Epidemiology and End Results (SEER) data, about 15 percent of American men with prostate cancer succumbed to the disease.

Dr. Miles said, “Before PSA screening, the mortality rate in the United States was very similar to the one in this study. The issue truly is to educate the public and physicians about the appropriate use of active surveillance to avoid overtreating those men in whom treatment is not necessary at this time and perhaps may never be.”

This study was published in the May issue of BJU International.

Research funding came from the National Institute for Health Research (NIHR) Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London. No conflicts of interest noted.

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Review Date: 
May 11, 2013