When the PSA first came out, I was taught it was the mammogram for men. But breast and prostate cancer are different and the bottom line is that treatment in prostate cancer may not equate to increased longevity. In 2008, Annals of Medicine published the article I have summarized below......
Dr. Luterman
**********************************************************************
Prostate cancer is the most common non-skin cancer in men in the United States, and prostate cancer screening has increased in recent years. In 2002, the U.S. Preventive Services Task Force concluded that evidence was insufficient to recommend for or against screening for prostate cancer with prostate-specific antigen (PSA) testing.
Randomized, controlled trials and meta-analyses of PSA screening and cross-sectional and cohort studies of screening harms and of the natural history of screening-detected cancer were selected to answer the following questions: Does screening for prostate cancer with PSA, as a single-threshold test or as a function of multiple tests over time, decrease morbidity or mortality? What are the magnitude and nature of harms associated with prostate cancer screening, other than overtreatment? What is the natural history of PSA-detected, nonpalpable, localized prostate cancer? Few eligible studies were identified. Long-term adverse effects of false-positive PSA screening test results are unknown.
Conclusion: Prostate-specific antigen screening is associated with psychological harms, and its potential benefits remain uncertain.
Ann Intern Med. 2008 Aug 5;149(3):I37.
Clinical Resources
Improve Your Teaching Skills
Search
Evidence-based Medicine
Medicolegal Resources
Calendar of Events
Have a suggestion?
We welcome any ideas on how to make this blog more user-friendly for you.
We also want to hear any suggestions for future faculty development events.
Please e-mail Sherry or Haider.
Contact us
Fran Geikie
Regional Program Administrator
(905) 397-1908 ext. 43870
geikie@mcmaster.ca
Sherry Hinder
Administrative Assistant
(905) 397-1908 ext. 43875
hinders@mcmaster.ca
Dr. Karl Stobbe
Regional Assistant Dean
stobbek@mcmaster.ca
Dr. Bruce Rosenberg
Coordinator, Faculty Development and Continuing Health Sciences Education
rosenberg@healthscreen.com
Dr. Kathy Swayze
Director, Student Affairs
swayze@mcmaster.ca
Dr. Maynard Luterman
Coordinator, Preclinical Education
mluterman@aol.com
Dr. Bob Josefchak
Coordinator, Clinical Education
orthodoc@vaxxine.com
Regional Program Administrator
(905) 397-1908 ext. 43870
geikie@mcmaster.ca
Sherry Hinder
Administrative Assistant
(905) 397-1908 ext. 43875
hinders@mcmaster.ca
Dr. Karl Stobbe
Regional Assistant Dean
stobbek@mcmaster.ca
Dr. Bruce Rosenberg
Coordinator, Faculty Development and Continuing Health Sciences Education
rosenberg@healthscreen.com
Dr. Kathy Swayze
Director, Student Affairs
swayze@mcmaster.ca
Dr. Maynard Luterman
Coordinator, Preclinical Education
mluterman@aol.com
Dr. Bob Josefchak
Coordinator, Clinical Education
orthodoc@vaxxine.com
Our campus is located in historic downtown St. Catharines:
View Niagara Regional Campus, Michael G. DeGroote School of Medicine, McMaster University in a larger map
Monday, November 9, 2009
Subscribe to:
Post Comments (Atom)
you wrote: "When the PSA first came out, I was taught it was the mammogram for men." I believe you are still correct but for reasons that are perhaps different than what you were originally taught. I happen to think that both tests share the commonality of being relatively useless. I think that, in the fullness of time, both will finally be proven to have been a waste of resources. It continues to be an issue for me that, not unlike the whole HRT fiasco, it is so difficult to prove that mammography has been a positive influence on breast cancer survival. It always worries me when it is difficult to prove that 'great things' are great. Wishful thinking and statistics are at opposite poles. I heard the other day that the American Can Soc is coming out with a new position statement that could make my thinking less radical. Interesting pearl. Since the male part in question arouses much less public interest that the female, men might have been spared a lot of unnecessary bother because of lower incidence of PSA tests vs Mammograms. Bruce
ReplyDeleteBruce,
ReplyDeleteI agree with you completely.
The evidence is that PSA does more harm than good. While it’s socially unacceptable to say the same about mammography I suspect the same is true. If we looked at cost-benefit and actual years of life saved – I suspect both tests will have trouble competing with “do nothing”.
Both diseases have long asymptomatic phases. Earlier diagnosis is just that – earlier diagnosis. No proof that it leads to improved long-term outcomes such as duration or quality of life. Most studies suffer from lead-time bias – you make a diagnosis 5 years earlier and demonstrate 5 years longer life expectancy from doing so. Go figure!
Karl