Widespread, opportunistic testing for prostate specific antigen (PSA) could be contributing the overdiagnosis of prostate cancer across Europe, researchers warn.
Their findings, in The BMJ, have implications for prostate cancer screening programs and initiatives such as Europe’s Beating Cancer Plan.
This EU project recently released recommendations from European Commission’s council proposing a gradual and well-planned implementation of screening programs for prostate cancer in men younger than 70.
The researchers found large differences in the incidence of prostate cancer that ran parallel with national trends in PSA testing.
This contrasted with more mild and steady decreases in deaths from prostate cancer, suggesting cancer overdiagnosis—where tumors are detected that would not progress to cause symptoms or death within a person’s lifetime.
Overdiagnosis can lead to unnecessary treatment, negatively affect quality of life, and lead to unnecessary expenditure on healthcare resources.
“The current high incidence of prostate cancer in many countries may be inflated by unregulated and opportunistic PSA testing that serves to mask any variations due to causal factors and may be indicative of overdiagnosis,” reports the team led by Salvatore Vaccarella, PhD, from the International Agency for Research on Cancer in Lyon, France.
“Careful monitoring and assessment of the benefits and harms, including overdiagnosis, will be essential for the potential implementation of EU guidelines and the prospective introduction of population-wide prostate cancer screening.”
Noting the need to assess epidemiological features of prostate cancer outcomes in Europe before initiating new screening approaches, the researchers compared data on men aged 35 to 84 years from 26 countries, 19 of which were in the EU.
The study included annual incidence rates of prostate cancer between 1980 and 2017 and mortality data from 1980 to 2020. It also included a review of research on the uptake of PSA testing across 12 European countries.
When all countries and periods were examined, there was up to a 20-fold variation in prostate cancer incidence but only a five-fold variation in deaths.
Prostate cancer incidence more than doubled in most countries from 1990–2017 in a way that ran parallel with the uptake of PSA testing, with the pace of increase varying according to country and time period.
Increases in incidence rose most in northern Europe, France, and the Baltic countries, notably in Lithuania where rates increased up to eightfold and peaked at 435 per 100,000 men in 2007.
The difference between the highest and lowest incidence rates across countries ranged from 89.6 per 100,000 men in 1985 to 385.8 per 100 000 men in 2007.
Death rates were much lower in absolute terms, ranging from 12 per 100,000 men in the Ukraine and Belarus in 1981 to 53 deaths per 100,000 men in Latvia in 2006.
Mortality rates across countries ranged from 23.7 per 100,000 men in 1983 to 35.6 per 100,000 men in 2006.
“The results of this new study emphasize the importance for any future implementation of prostate cancer screening to be carefully designed to minimize the harms of overdiagnosis, with careful quality assurance, assessment, and continuous monitoring of benefits and harms at the population level,” said Vaccarella.
