More questions surrounding prostate cancer screening. I have always maintained that screening for prostate cancer does not save lives. The USPSTF supports this. However, these are case-control studies – randomized trials are needed for a more definitive stance.

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  • dr john

    Right you are again, Kevin!
    The mathematicians say that because of “lead-time bias” and “lag-time bias”, the PSA test isn’t what it’s cracked up to be.
    The problem is that there are no longer any medical standards, only legal standards…
    Here’s a thought: I bet the same old coots with MBAs who tout “evidence-based medicine” all demand their yearly PSAs at their yearly physicals.

  • Anonymous

    yeah, i’m sure the mba’s are just dying to have a doc stick a finger up their butts

  • Anonymous

    How about instead of talking to individual patients which you don’t want to do because of fear of lawsuits, you do something to change public perception? Rein in your collegues that go on TV and recommend the test, check medical websites of various clinics that outright recommend it. If you work for a clinic and it has its website – start with it.

    Just out of curiousity, I checked a couple of websites. Most PSA-related “ask the doctor” websites make it sound like it is absolutely recommended for men over 50. They cite urology association, but forget to mention USPSTF.
    Write to them. Create your own website that clearly explains the evidence.
    I am not a great fan of tort lawyers, but shouldn’t you clean up your own house first?

  • james gaulte

    Are not lead time and lag time biases possible explanations for a positive effect of a screening procedure? Raising those possiblities as a possible reason for a finding does not exclude a causal relationship, it just rasies doubt.

  • Anonymous

    James, this is why the studies are needed that compare mortality across the group not how many years one lives after the cancer is found.
    If the increase in number of years one survives after diagnosis is not all due to lead-time bias than the mortality of prostate cancer in screened people should be lower than that in non-screaned people. This is not seen for PSA.

    If screened and non-screened people are dying at the same rate, than the increase in years one lives after the diagnosis is all due to lead-time bias.

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