Prostate cancer screenings using a controversial but widespread test are harming “significantly more men” than it helps, a preliminary report published on Monday revealed.
Researchers at the German Institute for Quality and Efficiency in Health Care (IQWiG) found that the benefits of prostate cancer screening using the PSA test are outweighed by disadvantages including false-positive results and overdiagnosis.
Prostate cancer was ranked the third most common cancer among Emirati men in 2011. Around 4,500 new cancer cases are recorded each year in the UAE and the country aims to reduce cancer fatalities by nearly 18 per cent by 2021.
“The screening does benefit some men by saving or delaying exposure to metastatic cancer. In return, however, significantly more men have to reckon with permanent incontinence and permanent impotence due to overdiagnosis and over-therapy, and this at a relatively young age,” the IQWiG said.
The PSA method of screening for prostate cancer measures levels of a protein called prostate specific antigen. If elevated levels of the protein are detected, a prostate biopsy can then be performed to take a tissue sample for further testing.
However, increased levels of the protein can often also be found in healthy men.
“PSA levels can go up for various reasons,” explained Dr Zaki Almallah from Abu Dhabi’s Cleveland Clinic, meaning “interpretation is riddled with difficulties”.
Biopsies following an initial test can then lead to infections and other complications.
“Screening measures can cause considerable damage,” said IQWiG head Jürgen Windeler.
“PSA screening in particular, results in a considerable number of overdiagnoses, which are stressful in themselves,” he said.
The screening technique, Mr Windeler explained, can lead to over treatment as most forms of prostate cancer are symptomless, causing “serious and long-lasting complications such as incontinence and impotence”.
“It is generally recommended that men with urinary symptoms or with a family history of prostate cancer get a PSA test,” said Dr Almallah.
“However, there is a genuine concern about over-diagnosis and subsequent overtreatment of prostate cancer, hence the recommendations are that men should be counselled thoroughly on the benefits and the risks involved in the process of diagnosis as well as the subsequent treatment,” he said.
The German report states that around two per cent of men who undergo prostate biopsies go on to experience complications.
The findings were based on 11 trials spanning an observation period of around 20 years.
More than 400,000 participants took part in total and the study did not show a notable change in the mortality rates among those screened for the cancer.
“Men who are not suspected of prostate cancer should not be offered organised prostate cancer screening using the PSA test,” Mr Windeler warned.
The IQWiG says it is “in good company” as almost all national health authorities and specialist societies worldwide speak out against population-based PSA screening.
Worldwide, prostate cancer is the second most commonly occurring cancer in men, with 1.3 million cases reported in 2018, according to statistics from the World Cancer Research Fund.
