Purgatory said...
Fresh off the press:
http://news.yahoo.com/psa-screening-doesnt-prevent-cancer-deaths-study-213400010.html
The SEER data from the National Cancer Institute prostate cancer just does not support the conclusions of this study and the USPSTF conclusion. Here is a summary of my review of the SEER data looking at pre-PSA period of 1975-79 vs post PSA period of 2001-07:
1. 5 year relative survival: 1975-79 was 69.2%; 2001-07 was 99.4% a very significant improvement.
2. Mortality rate per 100,000: For < 65yr 1975-79 was 2.618; 2001-07 was 1.818 a 30.5% improvement. For > 65yr 1975-79 was 235.23; 2001-07 was 180.67 a 23.2% improvement.
3. The 5 year relative survival for different stages from 2001-07 are: Local (organ confined) was 100%, Regional (lymph nodes involvement) was 100% and Metastasized was only 28.7% indicating early stage detection is critical to survival. Modern medicine were not able to improve metastasized survival that much.
4. Today, 81% of incidence are local and only 4% at detection are metastasized.
5. If I combined 1, 3 and 4, I can get a rough percentage of staging at detection today vs 1975-79 if I assumed the metastasized survival did not change significantly over the years: Today, 4% were metastasized and in 1975-79, roughly 40% of prostate cancer at detection were metastasized and that explained the improvement in survival today: EARLY DETECTION.
6. The number of lives saved due to improvements in early detection for a ten year period between 2001-10 were roughly 100,000 for people over 65 at detection and over 8,500 for people under 65 at detection. These are not small numbers, even for people under 65.
7. The 5 yr relative survival in 2001-07 for different age group told a very important story to support early detection: For people < 45, RS was 96.4% vs 98.2% for 45-54 age group vs 99.5% for 55-64 age group vs 100% for 65-74 age group. Why were people under 54 fare worst? My conclusion is that these age group, especially for people under 50 are not normally tested for prostate cancer, so many of them found out too late.
The USPSTF used some of the same statistics to come to a different conclusion: Someone stated that the under 65 age group mortality rate did not improve significantly, that we only saved .8 person per 100,000 by doing PSA screening. True, but multiply .8 by the average under 65 population of 107.5 millions came to saving 860 life per year, not a small number.
True, the cost of PSA screening can add up to a large number. If you multiply $100 per test by roughly the population of >45yr old male of roughly 50 millions strong, the annual cost is $5 billions, a large number. Perhaps that is why the USPSTF said it was not cost effective. Our lives are not worth that much.
Post Edited (Newporter) : 1/7/2012 8:11:44 AM (GMT-7)