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Study of 160k men finds no all-cause mortality benefit from prostate screening

nejm.org

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Re: Study of 160k men finds no all-cause mortality benefit from prostate screening

#3

Post by fishtoaster »

It looks like this is the 2 year follow up to a previous study.

"Analyses after 2 additional years of follow-up consolidated our previous finding that PSA-based screening significantly reduced mortality from prostate cancer but did not affect all-cause mortality. "

So, if I follow this correctly, your odds of dying from prostate cancer are still definitely lowered by screening, but your odds of dying overall are not. Perhaps this indicates that people who would have gotten prostate cancer are the sort of people (via lifestyle, genetics, diet, etc) who would die of something else anyway.

Re: Study of 160k men finds no all-cause mortality benefit from prostate screening

#5

Post by streptomycin »

To clarify the Hacker News title, the article is talking specifically about prostate-specific antigen (PSA) screening, which is already known to be of uncertain medical value except in some very specific situations. As the discoverer of PSA said, "I never dreamed that my discovery four decades ago would lead to such a profit-driven public health disaster. The medical community must confront reality and stop the inappropriate use of P.S.A. screening. Doing so would save billions of dollars and rescue millions of men from unnecessary, debilitating treatments." http://www.nytimes.com/2010/03/10/opinion/10Ablin.html

There are other more promising methods of prostate cancer screening in development that will hopefully be able to do better in the future.

Re: Study of 160k men finds no all-cause mortality benefit from prostate screening

#6

Post by carbocation »

fishtoaster wrote: post #3

It looks like this is the 2 year follow up to a previous study. "Analyses after 2 additional years of follow-up consolidated our previous finding that PSA-based screening significantly reduced mortality from prostate cancer but did not affect all-cause mortality. " So, if I follow this correctly, your odds of dying from prostate cancer are still definitely lowered by screening, but your odds of dying overall are not.…

This study basically folds in 2 additional years' worth of data, bringing the total study time to 11 years (or ~ 1.8 million man-years, in a sense).

I think your summary of the impact is a good one re: all-cause mortality.

It is curious, however, that there was a relative reduction in deaths from prostate cancer in the screened group. It turns out that the way randomization was done differed across countries. Detection of what procedures were done differed across groups. Treatment also differed across groups: for those randomized to screening, treatment was at major academic centers, suggesting that they may have had better care. I would think that this would make it more likely to cause a false rejection of the null hypothesis re: all-cause mortality, so I don't think it calls into question that part of the study. But it does trigger some concerns re: study design. A related editorial in the NEJM raises some of the points, too.

Re: Study of 160k men finds no all-cause mortality benefit from prostate screening

#7

Post by carbocation »

streptomycin wrote: post #5

To clarify the Hacker News title, the article is talking specifically about prostate-specific antigen (PSA) screening, which is already known to be of uncertain medical value except in some very specific situations. As the discoverer of PSA said, "I never dreamed that my discovery four decades ago would lead to such a profit-driven public health disaster. The medical community must confront reality and stop the inapp…

Yes, the HN title was only intended to capture what I saw as the most salient result of the study, whose actual title is "Prostate-Cancer Mortality at 11 Years of Follow-up".

I'd be happy to change the title if this one is considered too editorializing.

Re: Study of 160k men finds no all-cause mortality benefit from prostate screening

#8

Post by sachingulaya »

fishtoaster wrote: post #3

It looks like this is the 2 year follow up to a previous study. "Analyses after 2 additional years of follow-up consolidated our previous finding that PSA-based screening significantly reduced mortality from prostate cancer but did not affect all-cause mortality. " So, if I follow this correctly, your odds of dying from prostate cancer are still definitely lowered by screening, but your odds of dying overall are not.…

Prostate cancer is very, very slow to spread in most people. A pathology professor once remarked to me that he had never done an autopsy on a man over 70 who didn't have prostate cancer. Nothing in life is certain except for death, taxes, and prostate cancer ;).

Re: Study of 160k men finds no all-cause mortality benefit from prostate screening

#9

Post by bryanlarsen »

fishtoaster wrote: post #3

It looks like this is the 2 year follow up to a previous study. "Analyses after 2 additional years of follow-up consolidated our previous finding that PSA-based screening significantly reduced mortality from prostate cancer but did not affect all-cause mortality. " So, if I follow this correctly, your odds of dying from prostate cancer are still definitely lowered by screening, but your odds of dying overall are not.…

Somebody correct me if I'm wrong, but here's the way I understand it. One of the major problems with PSA-based screening is false-positives. Getting a false-positive result for cancer could certainly increase your risk of an early death. Cancer treatments put a lot of stress on you physically, and the diagnoses could also cause a lot of mental/emotional stress. Stress of either kind reduces life expectancy.
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