Piotr J. Wysocki: PSA screening does reduce prostate cancer mortality, but the overall benefit is small, according to a secondary analysis of the CAP trial
Piotr J. Wysocki, Head of Department of Oncology at Jagiellonian University Hospital, shared a post on LinkedIn:
“The primary analysis of the CAP (Cluster Randomized Trial of PSA Testing for Prostate Cancer ) trial did not reveal any effect of PSA screening on cancer mortality at a median 10-year follow-up. The secondary analysis has just been published in JAMA (doi: 10.10.1001/jama.2024.4011).
Patients participating in this trial, included in the investigational group, received a single invitation for a PSA screening test with subsequent diagnostic tests if the PSA level was 3.0 ng/mL or higher, and patients in the control group received standard practice (no invitation).
Within the study population (415,357), 12 013 and 12 958 men with a prostate cancer diagnosis were in the intervention and control groups, respectively. At a median 15-year follow-up, 1199 (0.69%) men in the intervention group and 1451 (0.78%) men in the control died of prostate cancer, which translated into a significant reduction of the risk of cancer-specific death (RR=0.92; 95% CI, 0.85-0.99; P=0.03). Compared with the control, the PSA screening intervention increased detection of low-grade (GG1) and localized (T1/T2) disease but not intermediate or high-grade (GG 7-8), locally- or distally-advanced tumors.
There were 45 084 total deaths (23.2%) in the intervention group and 50 336 total deaths (23.3%), but the difference in OS was insignificant (RR=0.97; 95%CI 0.94-1.01; P=0.11)
The secondary analysis of the CAP trial indeed demonstrates that PSA screening can reduce prostate cancer mortality. Taking into account the recent data on the role of MRI in prostate screening, which decreases the risk of overdiagnosis and minimizes the burden of unnecessary systemic biopsies, we may finally have robust data to support population-wide prostate cancer screening.”