They state:
The principal screening test was measurement of the serum PSA level with
the use of the Tandem-R/Tandem-E/Access assay (Hybritech). A positive
test result, defined as a PSA value of 3.0 ng per milliliter or higher,
was an indication for biopsy in most centers. Sextant prostatic biopsies
were recommended for all men with positive test results; lateralized
sextant biopsies4 were adopted in June 1996. Some exceptions to these procedures have been described previously.
That level of 3.0 is better than most, it is lower and has a higher false alarm rate and also higher detection probability on the ROC.
They continue:
The median screening interval was 4.02 years. A total of 6963 prostate cancers were diagnosed in the screening group (cumulative incidence, 9.6%) and 5396 in the control group (cumulative incidence, 6.0%), with approximately 1000 additional cases of prostate cancer in each study group, as compared with our earlier analysis
Here is a problem if one reads this correctly, namely it was too long a screening period.
Again the question to be asked is what PSA level and what screening interval yields the best if any survival. Then one can check the costs.
The issue is really also one of looking at PSA as a progression over time including % Free as well.
Now a Reuters report has some interesting comments:
Dr. Otis Brawley, chief medical officer of the
American Cancer Society, said the European study is actually eight
studies in eight countries, and only in Sweden and the Netherlands did
PSA testing significantly reduce the risk of death from prostate cancer. "Screening
saves lives if you live in the Netherlands and Sweden, but not the
other six places," he told Reuters Health in a telephone interview. One
factor that may have skewed the Swedish data, he said, is that men who
were screened were treated at an academic medical center, while men in
the control group who developed cancer were treated elsewhere in the
community. That alone might account for the lower mortality rate in the
PSA population. In all, there were 299 prostate cancer deaths in the screening group compared to 462 in the control group that was not screened. Brawley
said PSA testing is being widely promoted because "there's a huge
profit in screening and treatment" for prostate cancer, even though most
studies have failed to show that screening saves lives.
Strange in my opinion for ACS to advocate against screening, as they seem to be saying above.
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