Inventor of the P.S.A. Test Says It Was a Huge Mistake
American men have a 16 percent lifetime chance of receiving a diagnosis of prostate cancer, but only a 3 percent chance of dying from it. That’s because the majority of prostate cancers grow slowly. In other words, men lucky enough to reach old age are much more likely to die with prostate cancer than to die of it. Even then, the test is hardly more effective than a coin toss…
The results from the American study show that over a period of 7 to 10 years, screening did not reduce the death rate in men 55 and over.
The European study showed a small decline in death rates, but also found that 48 men would need to be treated to save one life. That’s 47 men who, in all likelihood, can no longer function sexually or stay out of the bathroom for long.
Full editorial on the inappropriate use of P.S.A. screening.
Very interesting. It seems that all the preventive/diagnostic procedures are under attack.
As usual, it is more helpful to read the actual paper than the spin. This study followed its “subjects” for 7 to 10 years.
According to the American Cancer Society, the five year survival rate for prostate cancer cases in the US in 2009 was 100 percent. The ten year survival rate was 93 percent. What are the chances that any 10 year followup is going to find a difference in deaths given these survival times?
As one would expect, the estimates from the study are imprecise–at 7 years PSA tests were “consistent with a reduction in mortality of up to 25% or an increase in mortality of up to 70%. At 10 years those rates were “17% and 50%.”
Furthermore, the authors point out that 44 percent of the men in the study and the control group had undergone one or more PSA tests when they entered the study. Deaths from prostate cancer for both groups in this study were 25% lower than those who were not tested, suggesting that the PSA tests weeded out a lot of cancers before people entered the study.
Finally, as the authors clearly state, “improvement in therapy for prostate cancer during the course of the trail probably resulted in fewer prostate-cancer deaths in the two study groups, which blunted any potential benefits of screening.”
Not reading that in the ObamaCare “we spend too much on health care PSA tests are a waste” crazed press, are we?
Thanks, Linda It’s always helpful to get your reaction to posts like this.
Hard to believe there is a campaign to reduce access to preventive and diagnostic tests but we do seem to see assualts coming with some regularity.
To government run health care systems, patients are costs. Since preventive care lowers individual risk but increases overall expenditures, government run systems tend to provide less screening than is the norm in the U.S. In the US, private payers happily spend to lower their individual risk and are actually allowed to spend money on it.
One of the easiest ways to get people in the U.S. to put up with the reduction in screening that will happen as government controls more of health care is to convince them that eeevviiiilllll doctors prescribe screening that doesn’t work.
It’s definitely true that other countries screen less. I had assumed that that was the reason our cancer survival rates are better.
To Linda: Actually, in government run health care, you’re a constituent and a voter. In commercial health care, you’re part of the medical loss ratio, the more you deny care, the better your medical loss ratio, the bigger your bonus.
Beyond that, the key point of the op ed is that the PSA test just isn’t effective. It says you have cancer when you don’t, and says you don’t have cancer when you do. When the inventor of the test come’s out so strongly against what will probably prove to be his most remembered invention, you have to take that very seriously.
There’s a widespread confusion among about the difference between survival rates and mortality rates. Survival is the length that elapses between discovering a illness and your death from it. Mortality rates are the percentage of people who die from an illness at a certain age. The experience in England is very instructive. Compared to the US, they don’t do much PSA screening. That makes their prostate cancer survival statistics look poor. If you look England’s prostrate cancer mortality, you find that your chance of dying from prostrate cancer is identical to the US. England may have a lower survival statistics, but that’s meaningless. Your life hasn’t been extended.
Artk,
In my comment, I merely point out that the press releases on the article differ quite a bit from what the article actually says.
The PSA test does not say whether or not one has cancer. However, it has been shown to correlate with cancer. Like many tests, it produces both false positives and false negatives. That’s life. The real question is whether its benefits are worth its costs to the individual paying for it.
A government bureaucrat may consider it a waste to screen 1,410 men to prevent an additional death from prostate cancer. Individual men might feel differently, especially in view of the fact that the test itself carries very low risk and, as medical tests go, is relatively affordable.
As you point out, incidence and survival rates present problems of interpretation. Fatality rates are another way to look at the disease burden. In 2004, the age-standardized mortality rate from prostate cancer in the UK was 27 per 100,000 (S. Westlake, Office of National Statistics). In 2002-2006, the age-standardized mortality rate from prostate cancer in the U.S. (SEER data) was 25.6 per 100,000.
Does this translate into “equal chances” of survival? That depends. As prostate cancer tends to kill in old age, in badly run health care systems people might die from other causes before they die of prostate cancer.
With respect to health insurance, a private company is held to its contract by both its customers and the government. While governments say they provide health care, Medicare, Medicaid, the Veterans Administration, the National Health Service, and the provincial systems of Canada make it quite clear that what governments say and what they do are often be two quite different things and it is very, very, difficult to hold government to account.
After showing high levels of PSA, a man usually suffers from a biopsy (which doesn’t show anything either), which can and have causes important infections to the patient.
Someone must be responsible for all these things.