Only one of every 20 diagnoses of prostate cancer that lead to benefits that would not exist without PSA screening, an analysis since 20 years.
An estimated 1 million more a diagnosis has been collected since 1986, and the incidence of prostate cancer remain far above the level that existed prior to widespread PSA screening, according to H. Gilbert Welch, MD, of Dartmouth Medical School in Hanover, NH, and Peter C. Albertsen, MD, of the University of Connecticut in Farmington.
Especially dramatic is the appearance of prostate cancer seven-fold greater occurs in men younger than pre-PSA era, Welch and Albertsen reported online in the Journal of the National Cancer Institute.
The authors conclude, "Given a lot of time that has elapsed since the PSA screening began, largely over this incident should represent over diagnosis.
"It's important that we begin to explicitly communicate with people who are considering screening a relatively large amount of death that are diverted to over diagnosed," they added.
"Over diagnosed in patients unable to benefit from treatment because their illness was not destined to grow and cause symptoms or death."
Findings add other parts of the long-standing debate about the risks and benefits of widespread PSA screening for prostate cancer.
Few doubts remain about the impact of PSA screening on prostate cancer diagnosis, and Albertsen said Welch. However, uncertainty has surrounded the effect of PSA screening on prostate cancer mortality.
To give another perspective to the debate, asked the author about the NCI Surveillance, Epidemiology, and End Results on age-specific database on incidents of prostate cancer and of course as initial therapy.
Using U.S. census data, they estimate the surplus or deficit in the diagnosis and treatment of prostate cancer, a year before PSA screening was introduced.
They found that the incidence of prostate cancer increases rapidly and then stabilized at a level much higher.
They found that the incidence of prostate cancer increases rapidly and then stabilized at a level much higher.
The tendency on the whole, however, the different age-specific trends, the researchers note.
Confidence intervals for all differences fall within the limits of statistical significance.
Combining all age groups, and Albertsen Welch estimates that an additional 1.3056 million men have been diagnosed with prostate cancer since 1986, and an additional 1.0048 million men have certainly treated.
"By using the most optimistic assumptions about the additional benefit of this is the diagnosis and treatment, that the entire decline in prostate cancer mortality observed during this period related to the screening - we estimate that approximately 56 500 deaths from prostate cancer have been avoided and approximately 23 people who have diagnosed and treated for approximately 18 that benefit everyone, "they said.
Noting that the treatment of prostate cancer risk, Welch and Albertsen concluded that more than one million American men have been "wasted exposure" to risk, financial implications, and anxiety associated with cancer patients.
In a joint editorial, Otis Brawley, MD, as chief medical officer of the American Cancer Society, said that the reason behind the 40% decline in prostate cancer mortality in the United States since 1993 are still unclear.
He noted that prostate cancer mortality has declined in some countries that do not have a PSA screening.
In a reference to the ongoing debate over national health reform, Brawley said "irrational tendency to adopt the technology without adequate care and assessment is a form of 'medical greed' and the main reason U.S. health care per capita income highest in the world. We did not get what we pay for life expectancy is 29th among developed countries. "
Brawley concludes that the number of complaints surrounding prostate cancer screening can be avoided "if we all know clearly what we know, as we know, what we do not know, like what we do not know, and what we believe, like what we believe and not what is believed to be confused with what is known. "
Interesting article strong reactions on both sides of the debate.
Patrick Walsh, MD, of Johns Hopkins, said the researchers ignore the fact that prostate cancer mortality dropped 28% in 1994 until 2009 and the definitive proof that the operation had reduced prostate cancer mortality rates as much as 50% in 10 years.
"The problem with a simple article," said Walsh. "In 1986 there was a large reserve for the sophisticated people in the population, without symptoms, prostate cancer is not curable, so that when they are diagnosed with cancer, treatment had no effect on their results.
"Then, beginning in mid to late 1990s, finally we see the man who can be cured and who will live long enough to be cured, but if they are not treated, then they will experience approximately 15 to 20 years will die from the disease, a time that has not passed. "
Edward Gelmann, MD, from Columbia University in New York City, said the limitations of PSA testing that it does not help to differentiate between men who have a cancer that must be addressed and they are not necessary.
"What's really needed is a sign that distinguishes between the lazy and more active than type of cancer," said Gelmann.
Mark Soloway, MD, of the University of Miami, said that increased use of active surveillance may give men a "chance to avoid the morbidity of treatment and took the opportunity to progress little if they delay or avoid treatment."
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