A very disturbing study from Harvard Medical School shows that intensive screening for prostate cancer and very aggressive treatment does not save lives. Doctors compared the death rate from prostate cancer between Seattle, Washington where there is heavy intense screening and very aggressive treatment for prostate cancer, and the state of Connecticut where screening and treatment are more lax. Intense screening for prostate cancer along with intense treatment failed to decease the death rate from prostate cancer.
Intense screening with PSA blood tests, an intensive campaign to make doctors aware that they could diagnose prostate cancer very early, and then very aggressive treatment with radiation and surgery did not save more lives than minimal screening and less destructive and abusive treatment. In Seattle, more men were screened for prostate cancer with PSA blood tests, and then more men were treated aggressively for prostate cancer; and the death rate from prostate cancer was the same as in Connecticut where there was less screening and less treatment.
This is the second study to show that aggressive screening and treatment for prostate cancer does not save lives. Seattle-Puget Sound area in 1987-90 had one of the most intensive screening and treatment for prostate cancer in the world. The State of Connecticut had no such program. 94,900 men, aged 65-79 in Seattle, and 120,621 in Connecticut were compared on all aspects of prostate cancer: rates of screening for prostate cancer, treatment with radical prostatectomy and external beam radiotherapy, and prostate cancer specific death rate. The prostate specific antigen PSA testing rate in Seattle was almost 6 times that of Connecticut. That means that 6 times as many men in Seattle were screened for prostate cancer, and the prostate biopsy rate was almost two and half times as frequent as that in Connecticut during 1987-90. Over 10 years, the Seattle men had almost five times as many radical prostatectomies and more external beam radiotherapies. The adjusted death rates in Seattle and Connecticut were exactly the same.
The professors at Harvard Medical School who conducted this study concluded: " The more intensive screening for prostate cancer and treatment with radical prostatectomy and external beam radiotherapy among Medicare beneficiaries in the Seattle area than in the Connecticut area was not associated with lower prostate cancer specific mortality over 11 years of follow up." We have to wait for further tests to see if the treatment for prostate cancer that causes emotional problems, impotence and incontinence really helps to save lives. It certainly causes more suffering.
Natural experiment examining impact of aggressive screening and treatment on prostate cancer mortality in two fixed cohorts from Seattle area and Connecticut. British Medical Journal, 2002, Vol 325, Iss 7367, pp 740-743. G LuYao, PC Albertsen, JL Stanford, TA Stukel, ES WalkerCorkery, MJ Barry. Barry MJ, Harvard Univ, Sch Med, Boston,MA 02215 USA
Reported 11/10/02; checked 8/9/05
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