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In 2012 the US Preventative Services Task Force (USPSTF) recommended against routine use of the prostate-specific antigen (PSA) test. A new study reconciles differences between two large trials cited by the group, concluding that there is evidence that PSA screening reduces prostate cancer mortality.

The USPSTF previously used two randomized clinical trials as it main evidentiary sources regarding screening for prostate cancer, with one study showing a drop (by about a fifth) in the risk of death from prostate cancer associated with the use of the PSA screening blood test. The second study found no advantage in mortality with screening. The new study looked at why the studies came to such different conclusions.

Here’s what they found: The negative (no advantage to screening) trial had serious flaws, including study design and implementation (think adherence) and practice settings. As a result, the authors did not really compare the trial groups as if they represented screened and non-screened populations. Then the new study authors accounted for differences in screening intensity, this translated into estimates of 25-31% and 27 to 32% lower risk for prostate cancer death with screening as performed by study #1 and study #2, respectively (European Randomized Study of Screening for prostate Cancer and Prostate, Lung, Colorectal (ERSPC), and Ovarian Cancer Screening Trial (PLCO)).

The bottom line? PSA screening can significantly reduce the risk for prostate cancer death. Still, you and your caregiver should carefully review the benefits of screening against potential harm for informed clinical and shared decision making. We African-Americans, and those with a family history of prostate cancer should factor in our higher risk into decision-making. I’m Michael Hunter (and yes, I got my PSA).

Michael

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