New Studies Provide No Evidence for PSA Screening
Gina Kolata of the New York Times wrote a scathing indictment of PSA screening citing two studies published from March 2009 New England Journal of Medicine, considered the most important studies in the history of men's health.
PSA screening actually INCREASED MORTALITY in US Study.
The large US study, the PLCO, showed no mortality benefit from PSA screening.(see left chart).The Europeans, on the other hand, did much better. Their ERSPC study provided a 20% mortality reduction from PSA screening. However, this came at a high cost of significant over-diagnosis. Fifty men were treated for prostate cancer unnecessarily for every life saved. This treatment of surgery, radiation and hormonal castration is associated with erectile dysfunction (ED)and incontinence.
Left Chart: Courtesy of NEJM PLCO study data, Gina Kolata, NY Times. Note Men screenedwith PSA (black line) has higher mortality then unscreened men (red line).
One Million Male Victims -
OverDiagnosed and Overtreated Since 1986
Welch reported a very unpleasant finding in the August 2009 issue of the Journal of the National Cancer Institute. Since the invention of the PSA test in 1986, one million men have been treated for a clinically insignificant prostate cancer that did not require treatment. These are 1 million male victims, many suffering from side effects of treatment, such as erectile dysfunction and incontinence.
Left Image: Million Man March courtesy of Wikimedia Commons.
Take a look at the charts Welch used to arrive at his conclusions. See charts below: The upper brown data line shows annual incidence rate of prostate cancer, (the incidence). The lower chart shows mortality which was stable at 30,000 deaths per year. Notice the huge spike in detected cases when PSA testing was introduced (red arrow). Notice the INCREASE in Mortality in the lower chart (blue arrow) the same years as a spike in Incidence from PSA testing. The two peaks coincide (vertical green line connects the two charts at the peaks). Granted mortality declines afterwards, from 33,000 per year to 24,000 per year, but at a huge cost. We have eradicated 10,000 advanced prostate cancer cases per yearin return for a huge price paid in degrading the quality of life for 1 million men overdiagnosed and overtreated for insignificant disease.
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Source for above two charts: http://caonline.amcancersoc.org/cgi/content/full/59/4/225
Figure 3 and Figure 4 combined, FIGURE 3 Annual Age-adjusted Cancer Incidence Rates among Males and Females for Selected Cancers, United States, 1975à ‚¬" 2005. FIGURE 4 Annual Age-adjusted Cancer Death Rates among Males for Selected Cancers, United States, 1930à ‚¬"2005.
Sept 2009 BMJ and Archives of Internal Med Papers
Another series of papers just released in the British Medical Journal Sept. 24 2009, again criticizes mass PSA screening, advising against it. Another highly critical article, just published in the Archives of Internal Medicine by Dr Kirsten Howard from the University of Sydney's School of Public Health, showed that PSA Testing is not a major factor in prostate cancer mortality, and "many men with screen-detected prostate cancer are having cancer therapies for clinically insignificant cancers".
Why Doesn't It Work? Where Did We Go Wrong with PSA Screening?
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