Is PSA screening helpful?

I believe there is a clear benefit to screening  men with PSA.  I also believe that politics and policy colors the recommendations of groups that discourage screening for cancer.  I screen PSA for myself and I strongly recommend it to men in my family.

PSA screening was analyzed in two large trials.  The European Randomized Study for Screening of Prostate Cancer (ERSPC) was published in 2008. This study was twice as large as a similar, but flawed, US trial.  The European trial had longer follow-up, and was a much cleaner trial (no PSA screening prior to entry on the trial, better compliance in the screened group, much less PSA screening in supposed non-screened group).  It showed a clear and convincing 20% reduction of cancer deaths by the use of PSA screening. The study conclusions showed that by screening men 55-69 with PSA and offering regular follow-up, an increase in early detection was found, resulting in decreased deaths from metastatic disease.

The U.S-run Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial was published around the same time. In this trial (N Engl J Med 2009;360:1310-1319), 76,693 men at 10 US screening centers were randomized to annual PSA and DRE screening versus no screening. The results showed that there was no reduction in mortality in the screened group at 7 and 10 years. However, only 85% of the screened group actually received PSA screening, and over 50% of the control group indeed were screened outside of the trial, blurring any possible results. Likewise, almost 50% of the subjects in both groups were screened prior to the trial, which most likely selected out cases of more significant cancer even before the trial began.