"PSA [testing] in the last two decades has absolutely reduced the risk of mortality by 40 perce

F8 said...
or whether it might make sense to wait six months or a year and then have another look.
with a psa of 5.6 i'd be on it right now.

ed

The number constantly rising the last 2-3 years is why both urologists agree on the transperineal biopsy.

The SEER statistics that show a 44.3% reduction in PCa mortality in the US (between 1993 and 2009) has been ignored because it doesn’t “fit the big picture”. Those that ignore this number say that this reduction cannot be totally attributed to PSA testing. They say that new treatments and better medical procedures including new and improved ways of androgen deprivation are potentially the cause.

If such is the case, why hasn’t the same reduction happened in countries in which the PSA test is not in “widespread” use as it is here in the US? Sweden and the UK are examples of those, When compared to the US statistics, Sweden has seen a 6% increase in PCa deaths between 1993 and 2006 (the last statistic available). In the UK the rate increased by 1.7%.

Guess those “new and improved” medical procedures have not arrived there yet...

RalphV

The latest write up in the paper regarding the psa test was published by the U.S. Preventive Services Task Force, and on there web site  the write up confirms that there is no uroligists or cancer specialists on the board that published there findings. It might cause a lot of men to not get a psa test .

Post Edited (wingman63) : 5/23/2012 6:50:14 PM (GMT-6)

Tudpock18 said...
Ralph, actually if you go to the cancer research uk site, it shows that prostate cancer mortality in the UK dropped by about 20% over the past couple of decades. More importantly, if you look at the specific mortality rates between the UK and USA over the past three years they are remarkably similar. The SEER US data shows deaths per 100,000 in 2007 as 24, in 2008 as 22.8 and in 2009 as 22. In the UK the deaths per 100,000 in 2007 were 24.6, in 2008 were 23.9 and in 2009 were 23.7.

In other words, despite decades of PSA testing in the USA the current mortality rates are not significantly different than they are in the UK where PSA testing is rare. I suspect it is examination of data such as these that led the panel to their conclusion that PSA testing does not save lives in significant numbers.

I'm not saying that I totally buy their conclusions, just that the facts indicate that they might have a point.

Tudpock (Jim)

Jim, you cannot compare mortality data that is adjusted to different age-specific populations as is the data you presented. There is a significant difference in mortality between the two countries. Take the time to read:

Simon M Collin et al
An ecological study of prostate cancer mortality in the USA and UK, 1975-2004: are divergent trends a consequence of treatment, screening or artefact?Lancet Oncol. 2008 May; 9(5): 445–452.
PMCID: PMC2760747

Source:
http://tinyurl.com/7xzogsp

Also look at the mortality data by country at the WHO database and you'll see that while PCa mortality has been reduced in the US, in several EU countries the rates are about the same or even higher. It might not be totally attributed to the PSA use, but this cannot be ignored as it was by the USPSTF.

RalphV
Prostate cancer deaths by country
Who database: http://tinyurl.com/7m4szmh[url]

Ralph, I guess this is why you can prove anything with statistics!  Actually the study to which you referred DOES use age-adjusted data and the comparisons are with the age-adjusted SEER data and the age-adjusted Cancer UK data, i.e. the exact same comparisons that I used.  By the way, the WHO data is over 20% different than the SEER data.  Additionally, the study you quoted ended in 2004.  Since then, more age adjustments have been made in both SEER and Cancer UK.  So...I will give you that the RATES have fallen more quickly in the USA than in the UK.  HOWEVER, the actual age-adjusted mortality rates are still quite similar for the last few years for which data is available  So, despite wide-spread PSA testing in the USA, the actual mortality rates between a non-PSA-testing country (UK) and a PSA-testing country (USA) are very close.  That doesn't mean PSA testing is a bad thing, it just means that there is not conclusive data that proves the results of widespread PSA testing.

Also by the way, you may be interested in why age-adjusted data is used by studies like the one you quoted and the data I used.  This is directly from the Cancer UK web site and is similar to why SEER does this as well:

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Age-standardised rate

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Age-standardisation adjusts rates to take into account how many old or young people are in the population being looked at. When rates are age-standardised, you know that differences in the rates over time or between geographical areas do not simply reflect variations in the age structure of the populations. This is important when looking at cancer rates because cancer is a disease that predominantly affects the elderly. So if cancer rates are not age-standardised, a higher rate in one country is likely to reflect the fact that it has a greater proportion of older people.

So one must be cautious when using non-age-adjusted data because of the other noise that skews the results.  Of course, we also have to be careful when comparing countries or even states because there are a lot more variables than just PSA testing.

The bottom line for me is that Dr. S was significantly exagerating when he claimed the 40% drop in US mortality was "absolutely" due to PSA testing.

Tudpock (Jim)

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