A Cochrane Library update to its 2013 prostate cancer screening review finds that combining the standard prostate-specific antigen (PSA) blood test with additional blood markers and an MRI scan may be promising, but more research is needed.
Standard PSA screening has a well-known weakness: it catches many slow-growing cancers that would never have caused harm, pushing men toward biopsies and treatments that carry real risks of urinary, sexual, and bowel problems, noted a team led by Juan VA Franco, MD, PhD, senior editor of Cochrane Library. MRI can offer a clearer picture of whether a suspicious lesion actually looks dangerous, potentially allowing more targeted decisions about who needs a biopsy at all. Franco and colleagues published the updated review on May 15.
The review included analysis of data from six trials involving nearly 790,000 men and focuses on results from a trial of 60,745 men which tested this combined strategy. Rather than relying on PSA alone, the approach adds a kallikrein panel -- a broader set of blood protein markers -- to MR imaging of the prostate before any biopsy is performed.
The team noted that early results from this trial aren't straightforward, however. The combined approach detected overall roughly 85% more prostate cancers than no screening, including more early-stage and, notably, more advanced-stage cancers -- a finding that was unexpected -- but it is not yet clear whether this would translate into fewer deaths from prostate cancer or any cause, according to the authors.
"We found insufficient evidence on the potential harms of screening, such as biopsy‐ and treatment‐related complications," the group concluded. "Emerging alternatives, such as screening with a kallikrein panel and MRI, may have little to no effect on diagnoses of prostate cancer, but the results on mortality are not yet known."
Access the full review here.
