Researchers point out that inviting men with no symptoms to a one-off PSA test for prostate cancer does not save lives. This from the largest ever prostate cancer trial conducted over 10 years by Cancer Research UK-funded scientists and published in the Journal of the American Medical Association (JAMA). Researchers at the Universities of Bristol and Oxford found that testing asymptomatic men with PSA detects some disease that would be unlikely to cause any harm but also misses some aggressive and lethal prostate cancers. This highlights the flaws of a single PSA test as a way to screen for prostate cancer, and shows the need to find more accurate ways to diagnose cancers that need to be treated.
The CAP Trial, which spanned almost 600 GP practices and included more than 400,000 men aged 50-69, is the largest trial ever to investigate prostate cancer screening. The trial compared 189,386 men who were invited to have a one-off PSA test with 219,439 men who were not invited for screening. After an average of 10 years follow up, there were 8,054 (4.3%) prostate cancers in the screened group and 7,853 (3.6%) cases in the control group. Crucially, both groups had the same percentage of men dying from prostate cancer (0.29%).

There are about 174,650 new cases of prostate cancer annually in the US and about 31,620 deaths from prostate cancer. While some prostate cancers are aggressive and lethal, others are clinically insignificant and will never lead to any harm or death if left undetected. Ideally, aggressive prostate cancers need to be identified and treated as early as possible. But finding a cancer that would never have caused men harm during their lifetime can have a serious impact on quality of life, including the worry of a cancer diagnosis, the possibility of infection following a biopsy and impotence and incontinence following treatment.

Professor Richard Martin, lead author of the study said: “Our large study has shed light on a highly debated issue. We found that offering a single PSA test to men with no symptoms of prostate cancer does not save lives after an average follow-up of 10 years. The results highlight the multitude of issues the PSA test raises — causing unnecessary anxiety and treatment by diagnosing prostate cancer in men who would never have been affected by it and failing to detect dangerous prostate cancers. Cancer Research UK is funding work that will allow us to follow the men for at least a further five years to see whether there is any longer-term benefit on reducing prostate cancer deaths.”

Prostate cancer is the second leading cause of cancer death in American men, behind lung cancer. About 1 man in 41 will die of prostate cancer. Prostate cancer can be a serious disease, but most men diagnosed with prostate cancer do not die from it. In fact, more than 2.9 million men in the United States who have been diagnosed with prostate cancer at some point are still alive today.

Dr Richard Roope, Cancer Research expert, said: “The PSA test is a blunt tool missing the subtleties of the disease and causing men harm. This trial illustrated that we need to develop more accurate tools if we want to save men’s lives. We do not recommend that the PSA test should be routinely offered to men without symptoms. However, if a man is particularly worried about his risk of prostate cancer, he should have a full discussion about his risk with his doctor.”


Story Source: Read this article on ScienceDaily: Cancer Research UK. “One-off PSA screening for prostate cancer does not save lives.” ScienceDaily. ScienceDaily www.sciencedaily.com/releases/2018/03/180306141708.htm.


Dr. Lazar is part of Northern California Medical Associates (NCMA) and operates California HIFU in Santa Rosa. He is the medical director of HIFU Prostate Services, LLC, a leading provider of minimally-invasive prostate cancer treatments using High Intensity Focused Ultrasound (HIFU).HIFU is an FDA approved precise and targeted therapy that reduces the risk of complications caused by surgery and radiation. Focal Therapy is not associated with incontinence, and erectile dysfunction is just under 10%. Sparing of the urethra avoids scar tissue formation which, when present, may diminish the urinary stream. The eventual need for additional therapy is now under 10%.

Dr. Michael Lazar offers a HIFU Program in partnership with HIFU Prostate Services, LLC (HPS). HIFU Prostate Services, LLC (HPS) is a leading provider of minimally-invasive prostate cancer treatments using High Intensity Focused Ultrasound (HIFU). HIFU prostate treatments are available at San Francisco, Marin County, and Santa Rosa.

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