A groundbreaking European study has revealed a sustained long-term reduction in prostate cancer mortality through prostate-specific antigen (PSA) screening. However, the research also highlights a critical issue: overdiagnosis, where PSA screening detects slow-growing cancers unlikely to impact a patient's lifespan. To address this, the study advocates for risk-based screening. The European Randomized Study of Screening for Prostate Cancer (ERSPC) sheds new light on the long-term impact of PSA screening on prostate cancer mortality. The study, published in the New England Journal of Medicine, found a 13% relative reduction in prostate cancer mortality 23 years after screening began. Professor Anssi Auvinen, a key investigator, emphasizes that while PSA screening significantly reduces prostate cancer deaths, its effect diminishes once screening stops, disappearing within nine years. The study found that for every 456 men invited for screening, one death from prostate cancer was prevented, and for every 12 men diagnosed, one life was saved. However, the absolute benefit of PSA screening increases over time: after 16 years, one death was prevented for every 628 men, but by the study's end at 23 years, only 456 men needed to be invited to prevent one death. The main drawback of PSA screening is the detection of clinically insignificant cancers, leading to overdiagnosis. Some prostate cancers are so slow-growing that they remain asymptomatic even without treatment. Treating these low-risk cancers can cause more harm than good, reducing patients' quality of life due to treatment side effects. Risk-based screening emerges as a more effective approach, focusing on cancers that require treatment. The PSA test led to more diagnosed low-risk cancers but fewer advanced cases. Elevated PSA levels were found in 16% of participants, but only 24% of those men had confirmed prostate cancer. This suggests a significant number of unnecessary tests and procedures. Despite this, PSA levels remain an effective predictor of prostate cancer risk and mortality. Since the ERSPC study's inception in the mid-1990s, risk-based screening has advanced, with magnetic resonance imaging (MRI) helping to reduce overdiagnosis. Professor Auvinen suggests that risk-based screening could identify men at the highest risk of developing clinically significant prostate cancer. The study involved over 160,000 men from eight European countries, with a significant Finnish participation. While Finland lacks a national screening program, PSA screening is a topic of healthcare policy debate, given prostate cancer's status as the most common cancer in men and the second-leading cause of cancer death in Finnish men. Further research is needed to refine screening methods and ensure patient well-being.
