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New research pours more doubt on value of PSA testing

By Ian Quinn

There is insufficient evidence to support a nationwide screening for prostate cancer using PSA testing, conclude two new research papers.

According to the authors the PSA test cannot distinguish between lethal and harmless prostate cancer, leading to over-diagnosis and overtreatment of healthy men.

PSA screening is widely used in many countries but the Department of Heath has shied away from it because of the costs and doubts over its effectiveness.

The new papers, both published on bmj.com today, will cast further doubt over a programme being launched.

In the first study, a Swedish team of researchers set out to assess how well PSA testing predicted a future prostate cancer diagnosis.

Using PSA test results from 540 men and 1,034 healthy controls, they found that the PSA test did not attain the likelihood ratios required for a screening test, with only very low concentrations of PSA, less than 1ng/ml, virtually ruling out a diagnosis of prostate cancer during follow-up.

In a second paper, US researchers reviewed the benefits and harms of PSA screening, concluding that data on costs and benefits remained insufficient to support population based screening.

They added that the financial and psychological costs of false positive results, over-diagnosis and overtreatment of prostate cancer need to be measured more precisely.

PSA test results: not reliable enough to justify screening programme according to researchers PSA test results: not reliable enough to justify screening programme according to researchers

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