A national screening program with PSA tests would mean that many of the men aged 50-70 who would be offered to participate in the screening would be in danger of getting a prostate cancer diagnosis even though their cancer would never develop into any serious disease. The screening program, calculated per 1000 men, would mean that 35-50 cases would be diagnosed with prostate cancer, and it would result in 1-4 fewer deaths because of prostate cancer after 10-15 years. These numbers are in comparison with having no screening program. These 35-50 additional cases could be considered as overdiagnosis, as these men would not receive a prostate cancer diagnosis if they had not been PSA tested. About 30 of these men would receive unnecessary treatment as they would not develop any serious cancer without treatment. Most people who receive treatment for early-stage prostate cancer have impaired sexual function. Urinary leakage or rectal problems are also common side effects. These side effects may be disabling and so extensive that they have a very significant impact on sexual intercourse and the opportunities for active social life.
In recent years, several tests that can complement the PSA test to identify men who, despite an elevated PSA value, have a low risk of having a treatment intensive prostate cancer, have been introduced. These tests could reduce overdiagnosis and unnecessary treatment. Based on the evidence presented, the National Board of Health and Welfare has concluded that there is insufficient scientific support for the benefit / negative impact if the PSA sample is supplemented with some other test before tissue sampling.
The screening program assessed is based on a model where men aged 50-70 are offered to participate in PSA screening, followed by systematic tissue sampling for men who have a PSA value above a certain level. The time intervals between tests in the screening program are based on the latest measured PSA value, in accordance with the National Prostate Cancer Program.
This is a referral version of the recommendation. Comments on the referral will be received until May 9, 2018. All comments received are considered for the final version of the recommendation published in autumn 2018.
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