Mar
10
2010
I have written before about the uselessness of screening for prostate cancer in the past, which brought on the vitriole of some of my fellow MD bloggers, some of whom had vested financial interests in the perpetuation of this looney practice. But now we have none other than the inventor of the Prostate Surface Antigen (PSA) test, Richard Ablin, coming out to say today in an editorial that it is not only useless, but a public health disaster. He points out that 16% of men will be diagnosed with prostate cancer, but only 3% will die of it. The PSA is used to drive men with mildly elevated values into the medical machine that will leave them with medical bills, possible impotence and urinary problems. In spite of this, PSA testing was not shown to save lives in a US study I wrote about last year here.
In the editorial he writes:
I never dreamed that my discovery four decades ago would lead to such a profit-driven public health disaster. The medical community must confront reality and stop the inappropriate use of P.S.A. screening. Doing so would save billions of dollars and rescue millions of men from unnecessary, debilitating treatments.
In the heat of the moment around healthcare reform maybe we should pay attention to this instead of Billy Tauzin’s whining? Anyone listening?
Mar
19
2009
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.
In the
European Randomized Study of Screening for Prostate Cancer 182,000 men age 5-74 were randomly assigned to PSA screening every four years or not receive screening and followed for an average of nine years. There were more prostate cancer diagnoses and 20% fewer prostate cancer deaths in the screened group, a difference that was statistically significant. The absolute difference was 0.71 per 1000 men meaning 1,410 men would need to be screened and 48 men treated to prevent one prostate cancer death. There was no difference in overall death rates.
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.
