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PSA Screening for Prostate Cancer is More Effective Than Previously Thought, Especially for Black Men

PSA Screening for Prostate Cancer is More Effective Than Previously Thought, Especially for Black Men

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The words "prostate cancer" spelled out with scrabble tiles.

September is Prostate Cancer Awareness Month. Prostate cancer is the second most common cancer in men, and proactive screening can catch it early, giving men optimal opportunities for accessing treatment sooner.

Prostate-specific antigen (PSA) screening for prostate cancer has been shown to be more beneficial in preventing mortality than previously thought, especially for Black men, according to research from Weill Cornell Medicine, Fred Hutchinson Cancer Center, University Hospitals Cleveland, and Case Western Reserve University.

Previous research suggested that, while PSA screening appeared to increase prostate cancer detection slightly, PSA screening had little to no effect on overall mortality and only minimal benefits in reducing prostate cancer-specific mortality.1 At the same time, biopsy- and treatment-related complications from PSA screening can be considerable, resulting in potential hesitancy regarding PSA screening among patients who feel the potential risks of screening outweigh the benefits.  

A recent study takes a deeper look at the evidence by incorporating data spanning a greater time period than previous research—thus improving previous estimates of overdiagnoses and overtreatment—and recalculated estimates for men of all races and Black men, and found evidence to suggest that previous estimates on the effectiveness of PSA screening were low and should be revised.2

Specifically, previous research suggested that for every 23 men diagnosed with prostate cancer, only one death was prevented by screening. However, new research published in NEJM Evidence suggests that PSA screening in fact prevents 1 death in every 11 to 14 men diagnosed with prostate cancer. For Black men, who have historically been at higher risk of mortality and morbidity from prostate cancer, the benefits are even higher, with PSA screening preventing 1 death for every 8 to 12 men diagnosed.

“Complementary approaches to quantifying overdiagnosis indicate a harm-benefit tradeoff of prostate-specific antigen screening that is more favorable for Black men than for men of all races considered together,” the study authors wrote.3

These findings emphasize the importance of early screening for prostate cancer, and the importance of educating patients accurately on the benefits of PSA screening.  

Sources

  1. Ilic D, Djulbegovic M, Jung JH, et al, Prostate cancer screening with prostate-specific antigen (PSA) test: a systematic review and meta-analysis. BMJ. 2018;362. doi.org/10.1136/bmj.k3519.
  2. Weill Cornell Medicine. Benefits of PSA Prostate Cancer Screening Found to Be More Favorable than Previous Estimates, Especially for Blacks. May 15, 2022. https://news.weill.cornell.edu/news/2022/05/benefits-of-psa-prostate-cancer-screening-found-to-be-more-favorable-than-previous. Accessed September 14, 2022.
  3. Basourakos SP, Gulati R, Vince Jr RA, et al. Harm-to-benefit of three decades of prostate cancer screening in black men. NEJM Evid. 2022; 1(6):10.1056/evidoa2200031. doi.org/10.1056/EVIDoa2200031.