Prostate cancer deaths fall after screening program

NEW YORK (Reuters Health) - Prostate cancer deaths fell substantially in the decade after one Austrian state began free PSA screening tests for all men ages 45 to 75, according to a new study.

Researchers found that after the state of Tyrol began a program of free PSA screening and prostate cancer treatment in 1993, the expected death rate from prostate cancer dropped by 54 percent. That compared with a decline of 29 percent in the rest of Austria, where free screening was not available.

The findings, reported in the journal BJU International, suggest that routine PSA testing can save men's lives -- something that has long been an open question.

PSA tests measure the amount of a protein called prostate-specific antigen in a man's blood. Because prostate tumors cause PSA levels to rise, routine PSA testing can catch the cancer early.

But PSA screening is controversial because it is not clear that the benefits outweigh the risks. Prostate cancer is often very slow-growing, and PSA screening may lead to treatment of tumors that would never have become life-threatening; treatment can carry side effects, like incontinence and erectile dysfunction.

In addition, PSA concentrations can increase for a reason other than prostate cancer and confirmation of prostate cancer requires a biopsy of the prostate gland, which itself can have side effects, such as infection or bleeding.

However, in the current study, early detection through widespread PSA screening is likely the driving force behind the greater drop in death rates seen in Tyrol, according to the researchers.

Between 1993 and 2005, nearly 87 percent of men ages 45 to 75 in Tyrol had at least one PSA screening test, the study found. That was up from 11 percent before the free program began.

And while prostate cancer death rates declined throughout Austria during the same period, they fell faster in Tyrol.

"Before the program was introduced, prostate cancer death rates in the Tyrol were similar to the rest of the country," lead researcher Dr. Georg Bartsch, of the University of Innsbruck, said in a statement.

"But after the program was launched the death rate in the Tyrol started falling by an average of 7.3 percent a year, more than twice the 3.2 percent observed in the rest of Austria."

The researchers acknowledge, however, that routine PSA screening remains controversial, and questions such as which men stand to benefit most from screening are still unresolved.

In general, experts recommend that men speak with their doctors about the potential benefits and risks of PSA screening for them personally. The American Cancer Society recommends that doctors offer most men PSA testing and a digital rectal exam yearly, starting at age 50.

SOURCE: BJU International, April 2008.