Opportunistic PSA testing brings overdiagnosis, IARC analysis says

A new study in the British Medical Journal reinforces the need for carefully planned prostate cancer national screening programmes across Europe – to reduce both death rates and overdiagnosis.

The population-based study from the International Agency for Research on Cancer (IARC) examines prostate cancer incidence and mortality across Europe between 1980 and 2017. It concludes that patterns over this period, during which unregulated and opportunistic prostate specific antigen (PSA) testing became common, were “indicative of overdiagnosis”.

There were variations in incidence between countries, with rapid increases in some countries seemingly associated with uptake of PSA testing. At the same time, deaths were less variable between countries, with steady declines in most countries.

This divergence between incidence and deaths “suggests that the intensity and coverage of PSA testing has been a critical driver for the increasing trends in prostate cancer incidence in Europe,” say the researchers.

“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,” they explain.

However, they add that these patterns may not reflect current trends: “The use of pre-biopsy MRI and of targeted prostate biopsies compared with systematic biopsies alone, should reduce the number of men who will receive an unnecessary diagnosis of prostate cancer, and although changes in clinical practice are already occurring in some settings, they are too recent for any potential effect to be observable in our study.”

“To this extent, some proposals have been advanced, including the implementation of systematically designed, risk based national prostate cancer detection programmes aimed at reducing overdiagnosis and overtreatment and increasing equity.”