In a region of the snow-capped Austrian Alps, a mass-screening program for prostate cancer and subsequent appropriate treatment of detected disease have been shown to reduce the number of deaths, according to a report in the Journal of Urology, (Vol. 58, No. 3: p. 417-424).

The study adds to evidence that the PSA blood test to detect prostate cancer can reduce mortality by detecting disease at early stages, but decisions on whether to offer mass screening in a particular region or country still depend on several factors, say the authors.

The goal of the study was to monitor the impact of screening through a blood test for prostate-specific antigen (PSA), the authors write. The study followed men in the province of Tyrol, where the University of Innsbruck had introduced a free mass-screening program.

Some PSA screening had been introduced as early as 1989, but free screening began in 1993, says Georg Bartsch, MD, principal investigator of the study and chairman of the urology department at the University of Innsbruck.

In 1998, there were 22 fewer deaths from prostate cancer in Tyrol than would have been statistically expected for the age group 40 to 79, according to the article. In 1999, there were 18 fewer deaths than expected.

Compared to the rest of Austria, where free screening programs were not offered, Tyrol had a more significant reduction in mortality from prostate cancer, the authors write.

"The reduction in mortality is a result of PSA screening followed by adequate diagnosis and early treatment of any stage of prostate cancer," Bartsch tells ACS News Today.

"It is worth emphasizing that no screening test prevents death on its own," says Peter Boyle, PhD, director of the division of epidemiology and biostatistics at the European Institute of Oncology in Milan, Italy.

"There must be appropriate therapy available to treat those cases discovered with the test," adds Boyle, an epidemiologist who also is an author of this study.

From a broad public health standpoint, the issue over whether to offer mass screening to all men in a certain age group involves consideration of what happens after the test comes back positive, notes Robert Smith, PhD, director of cancer screening and cancer control for the American Cancer Society (ACS).

"The bottom line here is we have data from a county in Austria in which high rates of screening were achieved over a very short period, and we are able to compare the trends in that county with other counties in Austria that had much lower rates of screening," Smith says.

Smith says the results are as expected, with an initial increase in the incidence rate of prostate cancer in Tyrol, compared to the rest of Austria. But that increase includes cancers caught at an earlier (less advanced) stage.

When more new cases are diagnosed at an earlier stage than at a more advanced stage, it doesn't prove that screening can save lives, Smith says.

What must then be observed is a reduction in mortality rates. The study adds to the evidence that PSA screening, when followed with appropriate care, can save lives, he says.

The ACS recommends that health care providers offer the PSA test and a digital rectal examination (DRE) yearly, beginning at age 50, to men with at least a 10-year life expectancy.

The ACS also recommends that the men be given ample opportunity to discuss the benefits and risks of testing at annual check-ups, as well as the pros and cons of early detection and treatment.

Rather than directly recommending screening, Smith says, the ACS suggests that men should routinely have an opportunity to make an informed decision about testing. Men at high risk, such as African-American men and those who have a father or brother diagnosed with prostate cancer at an early age, should begin testing at age 45.

Not all prostate cancer is life-threatening, Smith says. Because it grows more slowly than most other cancers, many men die with it, rather than from it. On the other hand, he notes, it is the second leading cause of cancer death in men.

Today, according to Smith, most organizations recommend that health professionals be prepared to discuss the benefits and limitations of testing, and whether or not the benefits of treatment outweigh the potential side effects, such as incontinence and impotence.