The benefits of PSA screening for prostate cancer outweigh the harms, particularly for Black men, according to investigators presenting a late-breaking abstract at the American Urological Association’s 2022 annual meeting. Findings of the new analysis were also published concurrently in the New England Journal of Medicine.
Investigators employed 2 complementary methods to estimate prostate cancer overdiagnosis among men aged 50-84 years from 1986, the year before widespread PSA screening, until 2016. Using the Surveillance, Epidemiology, and End Results registry and US Census data, they examined the excess incidence of prostate cancer in a screened vs unscreened group. They also used a model of prostate cancer natural history (PSA trajectories) to assess the effects of various screening strategies.
For all races, the investigators estimated 1.5-1.9 million overdiagnosed and 0.9-1.5 million overtreated prostate cancers by 2016. Compared with 1986, there were 270,000 fewer prostate cancer deaths among men of all races and 55,000 fewer deaths among Black men in 2016.
The investigators assumed that half of the 270,000 excess prostate cancer deaths were due to PSA screening. To prevent 1 prostate cancer death, the number needed to diagnose (NND) and treat (NNT) would be 11-14 and 7-11 for all races, Jonathan E. Shoag, MD, of University Hospitals, Cleveland Medical Center, Case Western Reserve University School of Medicine in Cleveland, Ohio, and colleagues reported. For Black men, NND (8-12) and NNT (5-9) estimates were lower.
“These data constitute strong support for prostate-specific antigen screening particularly in Black men, for whom there is a paucity of clinical trial evidence,” according to Dr Shoag and his team.
“We show convincingly here that the tradeoffs of screening are remarkably favorable and make clear that young otherwise healthy men—in their 40s and 50s—should definitely have at least baseline PSA screening,” he said in a University Hospitals press release.
The investigators suggested that policy makers reconsider the utility of PSA-based prostate cancer screening, particularly for Black men.
Decreases in prostate cancer incidence after the USPSTF grade D recommendation in 2012 against routine PSA screening do not account for the favorable risk-to-benefit ratio, according to the team. “Rather, the apparent explanation for our findings is that mortality benefit accrues over many years and that the magnitude of benefit relative to harm was greater for Black men compared with the general population.”