Prostate Cancer Screening Recommendations 2014

Overview

• Source: Canadian Task Force on Preventive Health Care
• Topic: Prostate-Specific Antigen (PSA) Screening for Prostate Cancer
• Document: Patient FAQ on PSA Screening

PSA Test

• Definition: A blood test used to detect possible prostate cancer.
• Note: Elevated PSA levels could indicate prostate cancer but also benign conditions like BPH or prostatitis.

Recommendations Against PSA Screening

• Reason: Potential harms outweigh benefits.
• Current Alternatives: No other proven accurate screening tests for prostate cancer.

Potential Harms of PSA Screening

1. Biopsies and Complications:

   • Positive PSA results often lead to prostate biopsies.
   • Biopsies can cause complications such as:
     • Blood in urine or semen
     • Rectal bleeding
     • Infection
     • Hospitalization
     • In rare cases, death

2. Statistics on Complications (Per 1,000 Men):

   • 178 unnecessary biopsies
   • 21 severe complications requiring hospitalization
   • 2 deaths within 120 days due to complications

3. Overdiagnosis:

   • Detects slow-growing cancers that may not cause harm in a lifetime.
   • Almost half of cancers detected would not cause illness or death.

4. Harms of Treatment:

   • Many men choose treatment due to uncertainty.
   • Treatment complications include:
     • Short-term: Infections, additional surgeries, blood transfusions (114-214 men)
     • Long-term: Erectile dysfunction (127-442 men), urinary incontinence (up to 178 men)
     • Mortality: 4-5 men may die from surgical complications.

Statistics on PSA Screening

• Benefit:

  • 1 in 1,000 men may avoid death from prostate cancer with PSA screening.

• False-Positive Results:

  • A high number of men undergo unnecessary biopsies due to false-positive PSA results.

Conclusion

• Consultation: Men interested in PSA testing should discuss potential benefits and harms with their doctor.
• Evidence Source: Statistics from the European Randomized Study of Screening for Prostate Cancer (ERSPC).