Metastatic PCa cases would triple without PSA test

Eliminating the PSA test would be taking a big step backwards and would likely result in rising numbers of men with metastatic cancer at the time of diagnosis, according to a recent analysis.

The study, which was published online in Cancer (July 30, 2012), suggests that the PSA test and early detection may prevent up to 17,000 cases of metastatic prostate cancer per year. Data show that if age-specific pre-PSA era incidence rates were to occur in the present day, the number of men whose cancer had already spread at diagnosis would be three times greater.

"Our findings are very important in light of the recent controversy over PSA testing," said senior author Edward M. Messing, MD, of the University of Rochester Medical Center, Rochester, NY. "Yes, there are trade-offs associated with the PSA test and many factors influence the disease outcome. And yet our data are very clear: Not doing the PSA test will result in many men presenting with far more advanced prostate cancer. And almost all men with metastasis at diagnosis will die from prostate cancer."

To analyze the effect of screening on stage of disease at initial diagnosis, Dr. Messing and co-author Emelian Scosyrev, PhD, reviewed Medicare Surveillance, Epidemiology, and End Results data from 1983 to 2008. They compared SEER data from the pre-PSA era (1983 to ’85) to the current era of widespread PSA use (2006 to 2008), and adjusted for age, race, and geographic variations in the U.S. population.

Approximately 8,000 cases of prostate cancer with metastases at initial presentation occurred in the U.S. in 2008. Using a mathematical model to estimate the number of metastatic cases that would be expected to occur in 2008 in the absence of PSA screening, Dr. Scosyrev and Dr. Messing predicted the number would be 25,000.

The authors emphasized the study was observational and has some limitations. In particular, it is impossible to know whether the PSA test and early detection is solely responsible for the fewer cases of metastasis at diagnosis in 2008.

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