Quality of Life Effects of PSA Testing
23 August, 2012
In an interesting article in the New England Journal of Medicine, a group from the Erasmus Medical Centre in Rotterdam has studied the quality of life effects of PSA testing.
The European Randomised Study of Screening for Prostate Cancer (ERSPC) showed that PSA testing reduces deaths from prostate cancer by 21%. However, it also showed that 33 men need to be treated for prostate cancer to save one life. Because many prostate cancers are slow growing and will never cause a man any harm in his lifetime, we need to understand the balance between the reduction in deaths and the potential side effects from radical treatment, including incontinence and erectile dysfunction. Active surveillance is now a common treatment option which has helped considerably in reducing over-treatment and hence causing less harm.
This new study looked at the balance between benefits and harms by measuring “quality-adjusted life-years” using a computer simulation. It found that the benefit of PSA testing was diminished by loss of quality-adjusted life-years, but shows in a scientifically rigorous way that the benefits from PSA testing do indeed appear to outweigh the harms. There are some limitations to the study and further work is required before a definitive conclusion can be drawn. Nevertheless, it is an important step forward in resolving the controversy over PSA testing.
> New England Journal of Medicine: Quality-of-Life Effects of Prostate-Specific Antigen Screening