PCF Perspective on Recent New England Journal of Medicine Reports Concerning PSA Screening
Recent publications in the The New England Journal of Medicine question the effectiveness of PSA screening in reducing death from prostate cancer. These reports, from large randomized trials performed in North America and Europe, generated conflicting results. Analysis of the North American study showed no reduction in prostate cancer mortality attributable to PSA screening, while a 20% reduction in mortality was observed in the European study. Both investigations contained important information about PSA screening. As with any trial, there are complex methodological issues to be considered and the medical community will be evaluating these trials in more depth.
The PSA test, with its limitations, remains an important tool in the diagnosis and treatment of prostate cancer. At this point, specific clinical recommendations cannot be made and are best left defined within the patient-physician relationship.
The Prostate Cancer Foundation (PCF) actively funds global research aimed at creating new laboratory tests focused on improving the early diagnosis of prostate cancer. Unlike PSA, which is not cancer-specific, the methods we seek are those that would provide early identification of potentially lethal prostate cancer. These optimal tests will reduce unnecessary biopsies and resulting treatment morbidity. Stewarding research to develop such tests for clinical practice is a significant PCF goal.
Much progress has been made, yet more needs to be achieved. The PCF will continue to advocate for both private and government funding of prostate cancer research programs to advance more specific diagnosis, prognosis, and improved treatments for prostate cancer.
For the present, patients need to remain active participants in their health management in partnership with their physicians. Physicians need to fully present the pros and cons of PSA screening and, if necessary, treatment options.
A complementary web video presenting a scholarly discussion on these issues is available at http://www.nejm.org/perspective-roundtable/screening-for-prostate-cancer/. This video features commentary from Philip W. Kantoff, MD of the Dana-Farber Cancer Institute. Dr. Kantoff is a member of the PCF Therapeutic Clinical Investigation Consortium.
The purpose of the PCF is to one day put ourselves out of business by ending death by prostate cancer. To reach that goal, we are committed to funding research that can replace the existing PSA test and deliver new, more specific diagnostic tools.
NEJM Discussion Transcript (PDF)
Learn more about PCF-Funded Research
Read About the Latest Developments from PCF’s 2008 Scientific Retreat (PDF)
Press Release: March 23, 2009
A JOINT STATEMENT FROM AMERICA'S PROSTATE CANCER ADVOCACY, EDUCATION, AND SUPPORT ORGANIZATIONS
Since 1993, when the PLCO trial was started, we have awaited the results of this trial with eager anticipation, as have others. The initial report of the results of this study -- and those of a comparable European trial -- published last week in the New England Journal of Medicine have told us two things:
- The studies offer conflicting evidence about the possibility of a prostate cancer-specific survival benefit associated with the regular use of prostate specific antigen (PSA) testing and digital rectal examination (DRE).
- These studies provide no convincing evidence that mass screening of men over 50 or 55 years of age will lead to a prostate cancer-specific survival benefit within 10 years.
We have come together to make two clear statements about these trials:
- Above all we thank the patients, the investigators, and the national authorities that funded these two trials for their efforts. The development and implementation of these trials over the past 16 years has been an enormous commitment by all concerned.
- We enthusiastically support the continued follow-up of patients in the prostate cancer arm of the PLCO study for at least a further 5 years, through 2014, as originally envisaged.
In addition, in the long-term interests of the health of every man in the USA, and with health reform recognized as a national priority, we wish to state the following:
- Every man, regardless of his age, has the right to know whether he is at risk from prostate cancer, a disease that still kills over 28,600 American men every year, and many more around the world. We encourage all men to be proactive, and to seek out information and support in regard to their health.
- We shall continue to encourage every man to discuss his individual risk for prostate cancer with his doctors, and to request the appropriate use of PSA and DRE tests until better options are available. Further clinical action based on results of these tests is also a matter for serious discussion between each patient and his physicians.
- We call upon the federal government to emphasize the need for more research into early detection technologies and methods that will lead to better and more accurate diagnosis of prostate cancer.
- We call upon Congress to increase funding for the Prostate Cancer Research Program at the Department of Defense.
- We call upon the National Institutes of Health to increase funding for prostate cancer research through the National Cancer Institute.
- We call upon the medical research community to place greater emphasis on the development of new clinical tests that can differentiate between those men at greatest need for aggressive prostate cancer treatment and those with indolent forms of the disease who can be well managed without invasive treatment.
This statement is approved by the following US-based prostate cancer advocacy, education, and support organizations:
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