This just in from the New England Journal of Medicine, two large studies adding futher evidence that much of our medical screening and interventions are doing more harm than good, this time with the Prostate Specific Antigen (PSA) test, which is used to screen for prostate cancer in men. For the past twenty years, yearly PSA screening with rectal exam has been recommended, based, of course, on little or no evidence that it is useful, just the assumption that it “couldn’t hurt” or “if I had a cancer I’d want to get it out.” So most American men get the tests. The Europeans do it much less commonly, as one of them pointed out “we think differently about these kinds of things than the Americans.”

Oui oui.

So on to the studies. The first study from the Americans, the Prostate, Lung, Colon and Ovarian (PLCO) Cancer Screening Study, involved 76,693 men who were randomly assigned to receive PSA screening and rectal exam every year for six years or have usual care. Although more prostate cancer was diagnosed in the screened group, they didn’t have more prostate cancer related deaths after seven years.

More prostate cancer diagnosed, but no difference in prostate cancer death rates

After ten years there were no differences in deaths between those who got screened (50) and those who did not (44), a 13% higher death rate in the screened group that wasn’t statistically significant.

No difference in mortality with screening for prostate cancer

Dr. B’s comment: Not all cancers are created equal. Most men identified as having abnormal tests will probably never develop a prostate cancer that will kill them (a similar situation holds for mammography). Prostate cancer screening is resulting in men getting a lot of unnecessary treatments that can be associated with impotence and incontinence. The lack of difference in death rates probably means that for every man “saved” from prostate cancer there is one many who has died from radiation treatments when their prostate cancer never would have killed him in the first place.