Can We Stop Now?

Prostate screening has no benefit

No part of the annual physical is more humiliating to a man than the "finger test" for prostate cancer.  It doesn't really hurt, but, well, 'it just ain't right.'  Now, from Sweden, news that all finger poking and PSA testing may not be saving lives in any case:

Nearly 1,500 men were randomly chosen to be screened every three years between 1987 and 1996. The first two tests were performed by digital rectal examination and then by prostate specific antigen testing.

The report concludes: "After 20 years of follow-up, the rate of death from prostate cancer did not differ significantly between men in the screening group and those in the control group."

The favoured method of screening is the prostate specific antigen (PSA) test.

However, around 15% of men with normal PSA levels will have prostate cancer and two-thirds of men with high levels of PSA do not in fact have prostate cancer.

One study has suggested that to prevent one death from prostate cancer you would have to screen 1,410 men and treat 48 of them.

The screening 1,410 doesn't sound so bad (just obnoxious), but the treating of 48 to save one sounds like overkill. Surgery and/or radiation often have terrible side effects.  Could it be that the way prostate cancer is treated needs to be reconsidered?  Most prostate cancer, especially in older men, is slow growing, and it has been said that more men die with prostate cancer than from it.

Now, the British Health bureaucracy is using this as justification to refrain from routine prostate screening:

Dr Anne Mackie, programmes director of the UK National Screening Committee, said: "This evidence provides further support for the recommendation the Committee made in November not to screen for prostate cancer at this time.

"At the moment the potential harms significantly outweigh the benefits of screening. We will re-assess the evidence for prostate cancer screening against our criteria again in three years, or earlier if new evidence warrants it." 

So, is this decision being made on a humanitarian basis over the negative effects of unnecessary treatment, or strictly a cost/benefit analysis?  It seems to me that screening should continue, but the basis for the decision to treat or not should be reevaluated.  

Damn, I talked my self out of not getting screened...