Psa Screening does Help

[Schwah]

practiceupdate.com/c/85298/...

This 16 year study showed that psa screening had a meaningful reduction in mortality at 16 years

Schwah

[strummer]

My husband fell through the cracks due to the recommended change of psa testing. so now is stage 4 gleason 9. with mets. tragic.

Dr Crawford at CU Med said he is seeing more younger men with late stage pca and felt it was due to lack of psa test. He never supported stopping the psa test.

I hope the word will get out to physicians to add psa screening again.

[Tall_Allen]

Or does it?One of the problems with ERSPC, as you can see below, is that there is considerable variability on follow-up treatment from country to country:

academic.oup.com/jnci/artic...

nature.com/articles/pcan20147

ncbi.nlm.nih.gov/pubmed/229...

In the largest trial of screening - 400,000 men randomized in the UK- found no benefit of screening on prostate cancer-specific mortality after 10 years. Maybe there will be a benefit with longer follow-up - who knows?

jamanetwork.com/journals/ja...

None of this addresses the more important questions:

• What is the best way to decide whether a man should get a PSA test?

• How do we insure that only those who need biopsies get biopsied?

• Should all African-Americans be screened? What about men with a family history?

• For men who are tested, how should the PSA pattern over time be used?

• Are there other PSA-based metrics that are more prognostic (e.g., PSA density)?

• Are there more specific PSA-based blood tests that should be used instead (e.g., PHI, 4KScore, IsoPSA)?

• Are there other non-PSA-based markers that should be used for screening or testing (e.g., SelectMDx, ExoDx Prostate Intelliscore, PCA3, etc.)?

• When can BPH be ruled out if PSA is elevated and rising? How should 5-ARIs be used to enhance diagnostic performance?

• How can prostatitis be ruled out when PSA is elevated and rising?

• Should DREs be used? How about ultrasound?

[Schwah in reply to Tall_Allen]

All great questions. But the 10 year study you mentioned seems flawed on the face of it given the high 10 year rate of survival for PC after initial diagnosis , right ?

[Tall_Allen in reply to Schwah]

No - it looks very reasonable to me- do you have different info?

[Schwah in reply to Tall_Allen]

No it just seems like a 10 year study on psa screening would have too few pc deaths (given the high 10 year survival rates for newly diagnosed pc patients) to provide meaningful data. While a 16 year study would be expected to have more meaningful results trumping any 10 year study. You look at a lot more of these than I TA. Is my thinking flawed?

[Tall_Allen in reply to Schwah]

You may be right - those that died within 10 years were diagnosed with advanced PC and would have died in that time regardless of screening. The authors acknowledge this, but write:

"Although the cumulative incidence of prostate cancer mortality in the intervention and control groups appeared to diverge after 12 years of follow-up, only 71/1196 of the prostate cancer deaths occurred after 12 years and an exploratory analysis found no significant change in the rate ratio over time. "

But also keep in mind that the UK study is MUCH larger then ERSPC. In another 5 years, it will provide much better info. Meanwhile, we still don't know if screening is a good idea.