The USPSTF Downgrades PSA Testing Using Bad ScienceBy
It has been in the news so I am sure that you are aware that the United States Preventive Services Task Force (USPSTF) has prepared a draft recommendation against prostate-specific antigen (PSA)-based screening for prostate cancer.
FYI the USPSTF has posted their draft report on their website which you can view here:
The Task Force will be accepting comments on this draft recommendation statement beginning Tuesday, October 11, 2011, and running through November 8, 2011. It is vital that all of us as well as our family members and our friends post comments beginning this Tuesday, October 11th at this website:
Despite the conclusions drawn by the USPSTF there is a lot of hard, scientific evidence that PSA screenings, along with digital rectal exams (DREs) do save lives. Just like mammograms which are plagued with the very same issues, PSAs save lives.
Malecare has joined with many of our friends from the other prostate cancer advocacy groups to speak with one clear voice about this issue. As a member of the Prostate Cancer Round Table, we will be issuing joint statements and calls to action to combat this misdirected policy, a policy that will cost many men their life.
Prostate cancer needs to be diagnosed early on, while it remains in the prostate gland. Once the disease leaves the gland there is NO cure. Advanced prostate cancer kills men, so our goal needs to be to stop men from developing advanced, metastatic prostate cancer.
According to an article in the New York Times, insurance companies are already reconsidering whether or not to cover PSA tests! According to the article both Aetna and Kaiser Permanente said it was unclear whether they would continue paying for the test. “We are currently reviewing the U.S. Preventive Services Task Force’s recent announcement on prostate cancer screening,” Jason Allen, a spokesman for Kaiser Permanente, said in an e-mail. “For our members who may have questions about the Task Force’s announcement, we encourage them to discuss the matter with their physicians.”
Our friends at Zero have prepared for the Round Table a number of scientifically based “talking points” that clearly demonstrate that PSA testing saves life. The talking points created by Kevin and Skip from Zero need to be repeated, again and again. The is an extract from their points: (thank you Kevin & Skip from Zero)
“ 44% decline in prostate cancer deaths
The Göteborg Randomized Population-based Prostate Cancer Screening Trial, a Swedish study partially funded by the National Cancer Institute, showed a 44 percent decline in prostate cancer deaths. This 20,000-man study was conducted during a 14-year period before PSA testing became prevalent in that country, thereby enabling the research to remain free of contamination issues such as those found in the PLCO study.
As a result of the Göteborg study, the National Cancer Institute in July 2010 acknowledged the “signification amount of contamination in the PLCO study because the men in the trial who had already undergone screening with a PSA test, which a number of researchers have said may preclude the (PLCO) trial from ever demonstrating a cancer-specific survival improvement.
Results of world’s largest randomized screening trial on prostate cancer:
The European Randomized Study of Screening for Prostate Cancer (ERSPC), which began in the 1992, involved more than 182,000 men (ages 50 to 74) in seven European countries who were followed over a 17-year period.
Four different analyses of the ERSPC data, based on an average 9 year follow-up review, show the following results due to PSA testing:
37% decline in prostate cancer deaths
By utilizing a control group of men from Northern Ireland, where PSA screening is infrequent, this research shows a 37 percent reduction in prostate cancer deaths when compared to men who were PSA tested as part of the ERSPC study. (European Journal of Cancer, Oct. 2009)
31% decline in prostate cancer deaths
This ERSPC analysis, which scrubs out data contamination issues and concentrates only on men who were actually PSA tested, shows a 31 percent reduction in prostate cancer deaths. (European Urology, July 2009)
27% decline in prostate cancer deaths
Another ERSPC analysis, also removing contaminated data, shows a 27 percent reduction in the prostate cancer death rate. (Reviews in Urology, Summer 2009)
20% decline in prostate cancer deaths
Preliminary ERSPC findings in early 2009 noted that PSA testing produced a 20 percent reduction in prostate cancer deaths. (New England Journal of Medicine, March 2009)
The PLCO Study – Flawed
A much smaller prostate cancer mortality study, called the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial, begun in 1992 in the U.S., involved more than 76,000 men ages 55 to 74.
A 7-year follow-up review showed no decline in prostate cancer deaths.
Data contamination issues, such as (1) allowing non-PSA tested men to be counted as tested, (2) letting control group members receive the PSA test rather than remaining untreated, and (3) using a shorter follow-up review period (7 years) as compared to the ERSPC study (9 years or longer), (4) utilizing an outdated PSA level cut-off point (4.0 ng/mL) as compared to the ERSPC study (3.0 ng/mL), and (5) being unable to more accurately detect prostate cancer cases, are among the reasons given as to why this study failed to show any reduction in prostate cancer deaths. ( 7,8)
Another analysis of the PLCO study concluded:
“Methodologically, the European (ERSPC) study seems to be superior to the American (PLCO) study. (9)
Decline in Prostate Cancer Deaths Due to the PSA Test
* 70% decline in prostate cancer death rate (10)
Randomized control trial of more than 46,000 men, ages 45 to 80, in Quebec from 1988 to 1996 reflected up to a 70 percent decline in prostate cancer deaths.
*62% decline in prostate cancer death rate (11)
Study of 1,300 men, ages 50 to 64, in King County, Washington from 1993 to 2007 showed PSA testing led to this major decline in prostate cancer deaths.
* 33% decline in prostate cancer death rate (12)
University of Innsbruck, Austria study of men, ages 40 to 79, from 1996 to 1999, concluded this 33 percent decline was due to making the PSA test universally available.
* 17.6% decline in prostate cancer death rate (13)
In the U.S., after several decades of gradually increasing death rates reached a peak in 1993, the prostate cancer death rate declined 17.6 percent, at an annual rate of 4.4 percent between 1994 and 1997, as PSA testing became more common.
* 10.9% to 16.1% decline in prostate cancer death rate (14)
PSA testing cut prostate cancer deaths by 10.9 percent among African-American men beginning in 1993 and by 16.1% among white men beginning in 1992, with continuing declines through 1997 for both races.
*9.6% decline in prostate cancer death rate (15)
In Canada, the age-standardized prostate cancer mortality rate fell 9.6 percent between 1991 to 1996 as a result of PSA testing.
Early Detection Is Key:
PSA Test Identifies Prostate Cancer Early, Before It Spreads
* 90% decline in advanced prostate cancer (16)
Due to PSA testing, 90 percent of all prostate cancers are caught before spreading to other areas of the body.
* 81.2% decline in advanced prostate cancer (17)
PSA testing is credited for the huge drop in advanced prostate cancer cases from 1997 to 2005.
* 75% decline in advanced prostate cancer (18)
Since the late 1980s, the PSA test has produced a 75 percent decline in advanced prostate cancer, more than for any other cancer.
* 70 to 80% decline in advanced prostate cancer (19)
Due to PSA testing, prostate cancer had not spread based on organ specimen samples.
* 65% decline in advanced prostate cancer (20)
Of 1,500 men with localized cancer followed between 1998 and 2002, those having regular PSA tests had a 65 percent chance of being diagnosed with a less aggressive form of cancer.
* 50% decline in advanced prostate cancer (21)
Rate of metastatic cancer fell more than 50 percent between 1990 to 1994 in U.S., and this is largely contributable to PSA testing.
* 41% decline in advanced prostate cancer (22)
Study shows that for every 25 men treated, one case of metastatic cancer will be prevented.
* 35% decline in advanced prostate cancer (23))
Toronto study of 700 men followed from 1999 to 2002 showed PSA testing reduced risk of metastatic prostate cancer by 35 percent.
* Regular PSA testing leads to less advanced cases of prostate cancer (24,25)
Several leading studies show the PSA test reduces catches prostate cancer early, before becoming more aggressive and spreading to other areas of the body.
Prostate cancer deaths have fallen more than 40 percent since 1993, yet the American Cancer Society gives no credit to the PSA test. Even the American Cancer Society acknowledges a 40 percent decline in prostate cancer deaths since the PSA test became widely used in the mid-1990s. Rather than give credit to PSA testing, ACS says the reduction in prostate cancer deaths could be due to other factors such as diet and lifestyle.
Tell that to the thousands of men whose life has been saved by getting a PSA test.
1. “2006 Fact Book” National Cancer Institute, U.S. Dept. of Health and Human Services.
2. “Mortality results from the Göteborg Randomised Population-based Prostate Cancer Screening Trial.” The Lancet Oncology. July 1,2010. Hugosson, J. et al.
3. “Prostate cancer mortality in screen and clinically detected prostate cancer: Estimating the screening benefit.” European Journal of Cancer, October 3, 2009. Van Leeuwen, P.J. et al.
4. “Prostate cancer mortality reduction by prostate-specific antigen-based screening adjusted for nonattendance and contamination in the European randomised study of screening for prostate cancer (ERSPC).” European Urology, July 28, 2009. Roobol, M.J. et al.
5. “Randomized trials of prostate cancer screening.” Reviews in Urology, Summer 2009; 11(3):179-180. Loeb, S. et al.
6. “Screening and prostate-cancer mortality in a randomized European study.” New England Journal of Medicine, March 2009; 360(13): 1320-1328. Schroder, F. et al.
7. “Does PSA testing save lives? – A Critical Analysis of Two Randomized Trials.” Dr. Patrick C. Walsh. Johns Hopkins University. 2009.
8. “Lower detection of prostate cancer with PSA screening in US than in European randomized trial.” Journal of the National Cancer Institute, February 8, 2010.
9. “The screening of prostate cancer in 2009: Overview of the oncology committee of the French Urological Association.” Prog Urol, January 2010, 20(1):17-23.
10. “Screening decreases prostate cancer death: First analysis of the 1988 Quebec prospective randomized controlled trial.” Prostate, February 1999; 38(2):83-91, Labrie F. et al.
11. “Prostate cancer mortality in relation to screening by prostate-specific antigen testing and digital rectal examination: A population-based study in middle-aged men.” Cancer Causes and Control, 2007; 18(9): 931-937. Agalliu, Ilir et al.
12. “Prostate cancer mortality after introduction of prostate-specific antigen mass screening in the Federal State of Tyrol, Austria.” Urology, 2001; 58(3):417-24. Bartsch G. et al.
13. “American Cancer Society guidelines for the early detection of cancer. Update of early detection guidelines for prostate, colorectal, and endometrial cancers.” CA: A Cancer Journal for Clinicians, 2001; 51:38-44, Smith R.A. et al; “Cancer statistics,” CA: A Cancer Journal for Clinicians, 2001; 51:15-36. Greenlee R.T. et al.
14. “Implications of stage-specific survival rates in assessing recent declines in prostate cancer mortality rates.” Epidemiology. 2000; 11:167-170, Tarone R.E. et al.
15. “Downward trend in prostate cancer mortality in Quebec and Canada.” Journal of Urology, 1999;161:1189-91, Meyer F. et al.
16. “Cancer Facts & Figures 2008.” American Cancer Society.
17. “Study shows massive drop in risk for diagnosis with more advanced forms of prostate cancer,” ProstateCancerInfoLink.com, August 28, 2009
18. “Drop in Prostate Cancer Mortality Rates During PSA Screening Era,” Dr. Cecilia Lacks, Spring 2009, www.drcatalona.com
19. “Comparison of digital rectal examination and serum prostate specific antigen in the early detection of prostate cancer: Results of a multicenter clinical trial of 6,630 men.” Journal of Urology, 1994; 151:1283-1290, Catalona W.J. et al.
20. “Annual PSA screening reduces risk of prostate cancer deaths,” Bio-Medicine, October 23, 2005
21. “Population-based prostate cancer trends in the United States: Patterns of change in the era of prostate-specific antigen.” World Journal of Urology. 1997; 15:331-335, Stephenson R.A. et al.
22. “Randomized trials of prostate cancer screening.” Reviews in Urology, Summer 2009; 11(3):179-180. Loeb, S. et al.
23. “Screening with prostate specific antigen and metastatic prostate cancer risk: A population-based case-control study.” Journal of Urology, August 2005. 172(2): 495-499. Kopen, J.A. et al.
24. “Consistent PSA Screening Results in Better Prognosis,” Brigham and Women’s Hospital (affiliate of Harvard Medical School) news release, August 12, 2008
25. “Physician Trust, Early Screening Reduces Disparities for Prostate Cancer,” ScienceDaily, July 29, 2009”
We need you to take action. Help save other men. Speak with your fellow survivors , friends, family, coworkers and neighbors. Explain to them the situation and enlist their cooperation. Speak with your local media and teach them about the realities of PSA testing. Point out that the traditional understanding, “garbage in, garbage out”, specifically applies to the PLCO Study that the USPSTF is basing its decisions on is simply bad science.
Register your PSA story at www.PSAandMe.org
GARBAGE IN – GARBAGE OUT
Joel T Nowak, M.A., M.S.W.