Some fifteen years ago there were two studies in the New England Journal of Medicine. In my opinion at the time they were fatally flawed. They were regarding PSA tests for prostate cancer. The basis of the flaw in my opinion was that there are two types of PCa, indolent and aggressive. That frankly is my classification based upon some forty years of observation. I have written extensively on the topic so I believe I bring some knowledge to the table. Frankly we do not know yet how to distinguish indolent from aggressive. Yet the best we can do is PSA and %Free tests with time based statistics.
I have examined such statistics for patients taken over 30+ years. They provide some insight but not dispositive.
The flaws in the older reports was the PSA tests were given every 4 years! The aggressive version can only be determined with tests every 6 months! That is how fast things change. If you only do the former you miss the latter. It was a plain and simple time sampling error. Recently it was corrected.
The NY Times now notes:
The previous A.C.S. guideline essentially left it up to men, starting at age 50, to make an informed decision with their doctors about whether to undergo a P.S.A. test, which is done with a blood draw. The U.S. Preventive Services Task Force, a government advisory panel that also makes screening recommendations, gave the same advice for men ages 55 to 69. In 2023, less than 40 percent of men in that age group received a P.S.A. test. In explaining the decision to recommend screening every two years, Robert Smith, senior vice president of early cancer detection science at the A.C.S., cited a new follow-up study on a randomized controlled trial of prostate cancer screening in Europe. After 23 years, the risk of death from prostate cancer was 13 percent lower among men who were screened regularly compared with those who were not screened — meaning that about two deaths from prostate cancer were averted per 1,000 men screened.
One wonders how many men died due to this in my opinion obvious flaw.
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