The benefit of PSA screening was diminished by loss of QALYs owing to postdiagnosis long-term effects. Longer follow-up data from both the ERSPC and quality-of-life analyses are essential before universal recommendations regarding screening can be made.
I have written a few years ago about the QALY, an oftentimes Brit concept to justify rationing. Carefully read the conclusion, if such be the case. It is not a conclusion but an opinion. They continue:
We predicted the number of quality-adjusted lifeyears (QALYs) associated with screening using utility estimates for various health states. The utility estimates were obtained from the Cost-Effectiveness Analysis Registry16 and additional studies 17-33 and ranged from 0 (death or worst imaginable health) to 1 (full health). In addition, we analyzed data from ERSPC on treatment-related complications, such as urinary incontinence, bowel dysfunction, and erectile dysfunction. Favorable and unfavorable values were assigned according to the minimum and maximum values in the cited references. A utility estimate of 0.99 was used for the screening phase...
Now a QALY is a rigged value which is oftimes the selection of the "researcher". If one has a choice between erectile dysfunction and death, perhaps death for some is a better alternative. But allowing one to assume that all fear such an outcome as compared to bone met induced death is rather extreme. Yet we must remember that the Dutch do allow and support euthanasia.
They conclude:
In conclusion, this study quantifies how much of the benefit of the overall reduction in prostate cancer mortality in the ERSPC must be adjusted when the harms are taken into consideration. It is essential to await longer follow-up data from the ERSPC, as well as longer-term data on how treatment and active surveillance affect long-term quality of life, before more general recommendations can be made regarding mass PSA screening.
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