Please note the links to prostate cancer risk calculators such as those generated from the ERSPC ROTTERDAM (www.prostatecancer-riskcalculator.com), the Prostate Cancer Prevention Trial (PCPT) (http://deb.uthscsa.edu/URORiskCalc/Pages/uroriskcalc.jsp), and from Canada (prostaterisk.ca), are useful tools to help men understand the risk of prostate cancer.

This essay was written by Sigrid Carlsson, MD, PhD, from the Memorial-Sloan Kettering Cancer Center in New York City and Göteborg University in Sweden.

Highlights include:

1. The largest active prospective trial of PSA screening is the European Randomized Study of Screening for Prostate Cancer (ERSPC) is still ongoing. A very recent analysis from the ERSPC that used at a follow-up of 11 years median continues to show that the screening, as practiced in Europe, significantly reduces prostate cancer mortality by about 20% (relative risk, 0.79; 95% confidence interval, 0.68 – 0.91; P = .001).

According to the authors, because the USPSTF used the ERSPC and mixed the data with other trials that had methodological problems, including the US Prostate, Lung, Colorectal and Ovarian Cancer (PLCO) trial, which had a high rate of “contamination,” with more than half of the men in the control (no testing) group receiving PSA testing outside the study by year 6 of the trial. By combining analysis of all trials created mix of confounding results.

2.  USPSTF assessed whether or not PSA testing decreases overall mortality (and not just disease-specific mortality). Only disease-specific mortality is statistically robust in these cancer screening trials, say the essay authors.

3. The USPSTF authors state that, in screening trials, “48 men received treatment for every prostate cancer‐specific death prevented.” “This is false,” write the essay authors, who say this number (48) was calculated from the number of men diagnosed, not the number treated.

4. In addition, there is a further problem with this statistic: it depends on length of follow-up. For instance, in the long-running Göteborg trial, the number needed to diagnose to prevent a death is only 12 (at 14 years of follow-up). This number is much higher, at 37, for the ERSPC, which has less follow-up, they explain.

Author’s conclusions included:

“First, avoid PSA tests in men with little to gain. There is no justification for recommending PSA screening in asymptomatic men with a short life expectancy,” they write.

Second, do not treat men with low-risk prostate cancers immediately. “A high proportion of men with screen-detected prostate cancer do not need immediate treatment and can be managed by active surveillance,” the authors say.

“Third, refer men who do need treatment to high-volume centers.” Having more patients treated by high-volume providers “will improve cancer control and decrease complications,” the authors conclude.

My Impression:

Can’t agree more.