PSA and prostate cancer screening

So I read this catchy headline today: “Prostate test ‘all but useless'”:

The team studied prostate tissues collected over 20 years, from the time it first became standard to remove prostates in response to high PSA levels. Thomas Stamey, who led the research, said they concluded that the test indicated nothing more than the size of the prostate gland. “Our study raises a very serious question of whether a man should even use the PSA test for prostate cancer screening any more,” he said.

This confirms what has been suspected for awhile. There is absolutely zero data that PSA screening saves lives. To put screening into context, I quote two facts from Stamey (via WebMD) :

* Nearly all men eventually get prostate cancer. It’s found in some 8% of men in their 20s and in 80% of men in their late 70s, Stamey says.

* Relatively few men die of prostate cancer. In the U.S., Stamey says, there are 226 prostate-cancer deaths for every 100,000 men. So a man has only a 0.2% chance of dying from the disease.

Also, prostate screening is not without risks. Biopsies are no picnic, and side effects such as impotence and urinary incontinence are common. All this for a disease that affects nearly all men anyways and has a relatively low mortality rate.

So, will I stop using the PSA? Of course not. Again, this comes down to the evidence vs the real world debate that has been previously discussed. We live in a society where evidence doesn’t hold up in court. This study won’t change the way I practice, but certainly more attention is needed to focus our screening efforts.

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