Recent articles, reviews, reports and research relating to PSA (Prostate Specific Antigen) testing and PSA screening

No PSA Screening Would Triple Metastatic Prostate Cancer Cases at Diagnosis": CancerNetwork article dated 6 August 2012 discussing modelling undertaken by Prof. Edward M Messing et al at Rochester Medical Center. The article can be read online here. The text of that article plus an abstract of the study referred to can be downloaded as a 123 KB PDF file from our site here.

European Randomized Study of Screening for Prostate Cancer (ERSPC) study's 11-year follow-up analysis on PSA screening. In a press release dated 15 March 2012 the ERSPC indicated that one of the conclusions from the recently completed 11-year follow up study on PSA screening was that "...a man who undergoes PSA testing will have his risk of dying from prostate cancer reduced by 29%." In other summary reports of the ERSPC study a different statistic is often reported - namely a 21% reduction in risk. The 29% statistic related to men in the screening group who "... complied with regular screening", whereas the 21% relates to the reduction of risk amongst ALL men in the screening group, whether or not they complied. An interesting aspect about the study is that according to a press release from another source, the reduction in risk occurred in only two of the eight countries participating in the study (Sweden and the Netherlands) - it would be of interest to determine what factors applied in those countries but not in the others.

In the
Financial Review of 25 August 2011 there is an article by Jill Margot reporting the apparent availability of a new type of analysis that is claimed to improve PSA’s diagnostic value. This is referred to as “Phi” - the Prostate Health Index. The article claims that the Phi index enhances the diagnostic accuracy of the level of total PSA and the ratio of free to total PSA. An analysis is made for an immature form of PSA in the blood. This information is then combined with data for free PSA and total PSA to estimate the likelihood of cancer being present. An image of the article as a 1.7 MB file in PDF format is downloadable from our site here.

Swedish prostate-cancer PSA screening study reported in The Lancet Oncology, Volume 11, Issue 8, pp 725 - 732, August 2010. This article by Prof Jonas Hugosson MD et al reports the results after 14 years of tracking of 9952 residents of Goteborg who were invited to participate in PSA testing every two years and another 9952 residents that comprised a control group. Of the 9952 in the screening group, 7578 actually attended the screening program. After 14 years, the numbers who had died from prostate cancer were 44 in the screening group, 27 of the attendees and 78 in the control group. Thus, the relative risk of men in the screening group dying from prostate cancer was 56% of that for the men in the control group. For the subset of men in the screening group who actually attended the program the relative risk of dying from prostate cancer was only 44% of that for the men in the control group. A major conclusion of the authors of the study is that “...a screening programme will decrease prostate-cancer mortality by as much as half over 14 years’ follow up.” A summary of the Lancet Oncology article is on this page. One interesting detailed discussion of the study can be found on Prostate Cancer Infolink and there are other discussions on the web.

Re-analysis of some data from the ERSPC PSA screening study. This reanalysis of data from the ERSPC (European Randomised Study of Screening for Prostate Cancer) study is reported by M J Roobol et al in the 30 July 2009 European Urology Journal pp 584-591. The ERSPC study findings reported initially in March 2009 indicated that PSA screening may reduce prostate cancer deaths by 20%. Roobol et al indicate that the 20% estimate “ influenced by two types of noncompliance: nonattendance in men who are randomised to the intervention arm and contamination (ie, the use of [PSA] testing in men randomised to the control arm).” Using data from the Rotterdam arm of the ERSPC, the authors concluded that: “After correction for both nonattendance and contamination, the mortality reduction increased by 50%, giving a PCa (prostate cancer) mortality reduction of 31–33% attributable to attending screening. This estimate represents the reduction of the risk of dying from PCa comparing men who accept an invitation to undergo PSA-based screening as carried out in ERSPC as compared with men who were not tested.” A copy of the full article can be read and/or downloaded as a 1.1 MB PDF file by going here and doing a Search for ‘Screening adjusted for nonattendance and contamination in the European Randomised Study of Screening for Prostate Cancer’ (without the quotes).