PSA Screening Fuels Overdiagnosis Across Europe

Prostate-specific antigen (PSA) screening is associated with a higher risk of overdiagnosis, with significant variation across European countries. This has now been confirmed by a study using cancer registry data, conducted by researchers from the International Agency for Research on Cancer (IARC).
Comparison Across 26 European Countries
PSA screening often leads to the detection of small, low-risk cancers that are unlikely to cause a threat during a patient’s lifetime. However, once identified, patients often undergo unnecessary treatments that can greatly reduce their quality of life. Overdiagnosis rates with PSA screening are considerably higher than those observed in breast, cervical, or colorectal cancer screenings. As a result, many European countries, including Germany, have opted against routine PSA screening for prostate cancer.
This decision is supported by an analysis of data from 26 European cancer registries, led by Salvatore Vaccarella of the IARC. The study examined prostate cancer incidence in men aged 35-84 between 1980 and 2017, using data from IARC’s Global Cancer Observatory. Mortality data from WHO datasets from 1980 to 2020 were also included in the analysis.
Incidence More Than Doubled 
The analysis revealed that between 1990 and 2017, the incidence of prostate cancer more than doubled in most countries following the introduction of PSA screening. The rate of increase varied by region and over time, with Northern Europe, France, and the Baltic countries experiencing the most significant increases. Lithuania, in particular, saw an eightfold rise in cases.
Mortality Rates Show Modest Decline
While incidence skyrocketed, the drop in mortality rates was much smaller and less consistent. Across all countries and time periods, the study found up to a 20-fold variation in prostate cancer diagnosis, but only a fivefold variation in death rates.
Study Limitations
These trends strongly suggest overdiagnosis, likely linked to PSA testing. However, as this was an observational study, definitive conclusions are limited. The analysis also lacked uniformity across age groups, time periods, and PSA testing criteria, with no data on cancer staging and treatment strategies. As a result, the findings should be interpreted with caution.
This story was translated from Coliquio using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. 
 
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