This may shock you, but it’s true
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Are these screenings more trouble than they’re worth?
Matt Cook here, and it’s common knowledge that prostate cancer screening is a wise decision for men over a certain age.
It’s common knowledge that these screening techniques can catch potentially lethal cancers early.
It’s common knowledge that these screening procedures could save your life.
It is common knowledge — but is it true?
The research says no.
It seems that random screening for prostate cancer for men over a certain age is entirely useless.
And as is always the case with unnecessary medical screening procedures, it may actually lead to harm.
The human research was carried out at Washington University School of Medicine in St Louis. The paper was published in the Journal of The National Cancer Institute.
The authors analyzed data from a previously conducted study which looked at a number of factors relating to different types of common cancers.
“The prostate component of the trial was undertaken to determine whether there is a reduction in prostate cancer mortality from screening using serum prostate specific antigen (PSA) testing and digital rectal examination.”
The researchers were interested in finding out whether random screening for prostate cancer…
…using the PSA blood test and digital rectal examination…
…could reduce the risk of death from prostate cancer.
There was a previous report from this study which found screening to be pretty much useless.
But more time had passed and the researchers wondered whether longer term data might show the benefits.
“Mortality after 7-10 years of follow-up has been reported previously. We report extended follow-up to 13 years after the trial.”
Over 75,000 men in their 50s, 60s and 70s enrolled in the study which began way back in 1993.
Men were still being enrolled up until 2001.
The men were randomly split into one of two groups.
One group underwent random testing every few years for prostate cancer.
The other group did not undergo any random prostate cancer testing.
They may have undergone targeted testing if their doctor suspected it may be necessary due to symptoms.
“Intervention was organized screening of annual PSA testing for 6 years and annual digital rectal examination for 4 years and control arms.”
The researchers had access to medical records for 13 years after enrollment in the study.
The medical records included information on all diagnosis of prostate cancers and all deaths from the disease.
The researchers analyzed the data taking care to correct for other important risk factors like age and comorbidities.
“Analysis was used to examine the interactions with respect to prostate cancer mortality between trial arm and age, comorbidity status, and pretrial PSA testing.”
There were slightly more diagnoses of prostate cancer in the men who had gone for random prostate cancer screenings.
“At 13 years, 4250 participants had been diagnosed with prostate cancer in the intervention arm compared with 3815 in the control arm.”
Screenings had caught an extra 12% of prostate cancers which would otherwise have been missed.
“… resulting in a relative increase of 12% in the intervention arm.”
It seems like a good argument for random prostate cancer screening.
But those results didn’t play out in terms of deaths from prostate cancer.
Deaths from prostate cancer were actually higher in the men who had gone for random prostate cancer screenings.
Random prostate cancer screening was associated with a 9% increased risk of dying from prostate cancer in this large study.
“Mortality rates from prostate cancer in the intervention and control arms were 3.7 and 3.4 deaths per 10 000 person-years, respectively, resulting in a non-statistically significant difference between the two arms (RR = 1.09).”
What’s more, the researchers were not able to identify any pre-existing risk factors which could have skewed the data and given an incorrect result.
“No statistically significant interactions with respect to prostate cancer mortality were observed between trial arm and age, pretrial PSA testing, and comorbidity.”
The researchers concluded that the long-term results of this prostate cancer screening research showed it to have no benefit.
“After 13 years of follow-up, there was no evidence of a mortality benefit for organized annual screening compared with opportunistic screening.”
It may be that the increased risk of death in those in the random screening group is due to the treatments which are often offered to men diagnosed with prostate cancers.
Because the theories about hormones and prostate cancer are incorrect, 180° wrong, the treatments can often do more harm than good.
You should always consult your healthcare practitioner for guidance on medical diagnosis and treatment.
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