News Release

Is prostate cancer screening the reason for decreased mortality in the USA compared to the UK?

Peer-Reviewed Publication

The Lancet_DELETED

The striking decline in prostate-cancer mortality in the USA compared with the UK from 1994-2004 coincided with a much higher uptake of prostate-specific antigen screening in the USA. However, speculation over the role of screening will continue until evidence from randomised controlled trials is published. These are the conclusion of authors of an Article published early Online and in the May edition of The Lancet Oncology.

Prostate cancer screening based on the prostate-specific antigen (PSA) test is almost routine in the USA, in 2001, 57% of men aged 50 years or older reported having a PSA test within the previous 12 months. By contrast, for each year between1999 and 2002, an estimated 6% of men aged 45-84 years were PSA tested in the UK. However, there is no robust evidence that routine PSA testing decreases prostate-cancer mortality. The most recently published comparisons of USA/UK prostate-cancer trends -- using data up to the late 1990s -- showed that rates in the USA had begun to fall more rapidly than in the UK, but the changes seemed too early to attribute to the effect of PSA screening.

Simon Collin, University of Bristol, UK, and colleagues analysed trends in prostate-cancer mortality in both countries between 1975 and 2004, and compared them with trends in screening and treatment. They found that mortality rates peaked in the early 1990s at almost identical rates in both countries. But after this period, the rate of decline of mortality in the USA (4.17% per year) was almost four times that in the UK (1.17% per year). The mortality decline in the USA was greatest and most sustained in patients aged 75 years or older, whereas death rates had plateaued in this age group in the UK by 2000.

The authors say that the difference in mortality could be related to different treatment and screening policies in the two countries -- for example the greater use of gonadotropin-releasing hormone treatment in older men, or more aggressive treatment of men with locally advanced and asymptomatic prostate cancer found through greater PSA testing in the USA. Another factor could be the misattribution of cause of death.

They conclude: "The decline in mortality from prostate-cancer in the USA is striking in comparison to the UK, but we can only continue to speculate about the relative contributions of differences in detection and treatment, or the relative balance of benefits and harms, until the publication of findings from trials provides the robust evidence that is so eagerly awaited."

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http://www.eurekalert.org/jrnls/lance/pdfs/TLOprostatefinal.pdf


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