NEW INSIGHTS into screening for prostate cancer have been uncovered as a result of the Cluster Randomised Trial of PSA Testing for Prostate Cancer (CAP) trial. The findings of the trial showed that a single prostate-specific antigen (PSA) test did not lead to a reduction in prostate cancer deaths at 10 years. Using PSA tests to screen for prostate cancer is an actively debated topic. Indeed, the U.S. Preventative Services Task Force (USPSTF) recommended against routine PSA screening for all ages in 2012 but then adjusted this recommendation in 2017; the USPSTF now recommends a personalised approach to screening males in the age category 55–69 years. Bearing in mind the ongoing debate around PSA screening set to the backdrop of straitened healthcare budgets, the results of the CAP trial are of great relevance.
The study population included 419,582 men aged 50–69 years who had been screened in any of the 573 primary care practices based in the UK. The study began recruiting in 2001 and follow-up ceased in 2016. While 4.3% of the screening population received a positive prostate cancer diagnosis compared with 3.6% of unscreened patients, this did not result in a statistically significant difference in deaths at 10-year follow-up. The death rate in the screening arm was 0.30 per 1,000 person years (549 out of 189,386 patients) whereas the corresponding rate in the control arm was 0.31 per 1,000 person years (647 out of 219,439 patients). The authors commented: “It has been hypothesised that screening men in their early 50s may be more effective than at a later age. However, we did not find statistical evidence to support this.”
While further follow-up from the CAP trial is still awaited, at present these results provide important evidence for medical bodies making recommendations. Although, as the authors noted, the findings contradicted the initial hypothesis, this does not detract from their value in guiding medical decision-making to ensure the optimum management of prostate cancer risk.
