The New England Journal of Medicine yesterday (18 Mar 2009) released before their scheduled publication date two large studies on prostate cancer screening. Both were relatively long (around 10 years) and were attempting to evaluate the usefulness of the PSA blood test, which we routinely do annually on own men over age 50.
To quickly summarize, one study (Mortality Results from a Randomized Prostate-Cancer Screening Trial) suggested there was no real mortality benefit to the screening and therefore the adverse effects of surgery or other treatment on men for high PSA were generally unwarranted.
The other (Screening and Prostate-Cancer Mortality in a Randomized European Study) looked at rather similar populations and concluded that PSA screening reduced the likelihood of death from prostate cancer by 20%, but was hardly a ringing endorsement of the process since it found substantial dangers of overdiagnosis.
The accompanying editorial by Dr. Mike Barry from MGH, whom I know well professionally, carefully dissected the vagaries of both these studies and then more or less concluded with a pox on both their houses, summarizing that the uncertainty about the usefulness of PSA screening was still unresolved.
Kate and I need to reflect much more on these studies and what their implications might be for our practice. We should have a clear (or at least clearer) discussion ready for you sometime next week.
I look forward to your additional thoughts. I hope a reliable test is in the works somewhere from which I will be able to profit.