PSA screening reduces prostate cancer mortality in long-term European study

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The European ERSPC screening trial began in 1993 and includes more than 160,000 men in Sweden, Finland, the Netherlands, Belgium, France, Switzerland, Italy, and Spain. The fifth – and so far most extensive – follow-up is now complete.

“This is the prostate cancer study with the longest follow-up and with very high quality throughout. The results clearly show that PSA screening lowers the risk of dying from prostate cancer even after more than 20 years,” says Jonas Hugosson, professor of urology at the Institute of Clinical Sciences.

The study was recently published in the New England Journal of Medicine. From Gothenburg, Jonas Hugosson, Rebecka Arnsrud Godtman, associate professor of urology, and Marianne Månsson, associate professor in statistics at the Department of Urology, contributed to the work.

Effective – but overdiagnosis remains a challenge

PSA screening has clear benefits, but it also has limitations.

“PSA testing carries a risk of overdiagnosis – finding slow-growing tumors that would never have caused symptoms. The study shows that for every death prevented, twelve men received a prostate cancer diagnosis, in which the majority of tumors were harmless and did not require treatment. This figure is lower than in previous analyses, but still substantial,” says Jonas Hugosson.

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Towards more precise screening strategies

The results highlight the need for approaches that better identify men at risk of serious prostate cancer while avoiding diagnosis of harmless cancers.

“New screening methods need to be evaluated. The largest ongoing study is Gothenburg 2, run at Sahlgrenska Academy. We are testing whether adding MRI for men with elevated PSA can identify those with significant cancer and avoid diagnosing men with small, harmless tumors who do not need a cancer diagnosis,” says Jonas Hugosson.

The G2 study includes about 37,000 men in Gothenburg and surrounding municipalities and has already resulted in two widely recognized publications. This and other studies have contributed to the EU now recommending that member states initiate organized prostate cancer screening projects.

Halved mortality in men under 80

Prostate cancer is the cancer type responsible for the greatest number of deaths among men. Around 2,200 men in Sweden die each year from the disease, and many are still diagnosed too late because symptoms often appear only when the cancer is incurable.

“Screening with PSA and new blood-based markers can diagnose almost all men at an early stage. Even without a national screening program, PSA testing has helped halve mortality among men under 80 over the past 15 years,” says Jonas Hugosson, and adds:
“Our studies show that organized testing reduces mortality. Equally important is reducing overdiagnosis and unnecessary treatment. With risk-based screening and better diagnostics – including MRI – a national screening program should be within reach.”

Text: Jakob Lundberg

Link to the publication in the New England Journal of Medicine