Map of life expectancy at birth from Global Education Project.

Tuesday, May 22, 2012

Like I've been saying . . .

The U.S. Preventive Services Task Force has held its ground on prostate cancer screening. They are against screening, for men of any age. And yes, the howls of outrage are echoing through the hospital and clinic halls, notably from the American Urological Association. Now I wonder why the AUA is "outraged"?

Ah. I have a thought. They make money by treating prostate cancer, and they make even more money by treating the incontinence and erectile dysfunction that results from the treatment. Here's what the USPSTF says, and it's not outrageous:

  1. The number of men who would have died of prostate cancer within 10 or 14 years (the follow-up time of the available studies), but who will not because they are screened, is possibly zero and no more than 1 out of 1,000. 
  2. 80% of positive PSA tests are false positives, but these false positive tests are followed by biopsies which in 1/3 of cases result in pain, fever, bleeding, infection or other problems that require further medical intervention. 
  3. 90% of men with positive biopsies will get treatment with surgery, radiation, or drugs to suppress their androgen. Five out of 1,000 will die within a month of surgery, and from 10 to 70 more will have severe complications. Twenty to 30% of them will have incontinence and/or erectile dysfunction.
  4. However, many of them -- probably most of them -- would never have died from prostate cancer even without treatment, because most of the "cancers" found on biopsy would never have progressed to cause disease.
So it's a no-brainer. Men who have been through this are convinced that it saved their lives, because who wants to admit that they went through all that for nothing? The doctors who treat them don't want to admit that they have been paid big bucks to harm people all these years either. And all the celebrities who made PSAs to promote PSA don't want to think they've been tools either.

By the way, there's no evidence that screening just by digital rectal exam is worth it either. I'm certainly not going for it.

1 comment:

roger said...

keep that digit in your pocket doc.