It's important to note that PSA research was largely conducted by Catalona in the 80's. Some consider his findings biased.
But not me. I consider him an elder statesman with strong insight on PSA screening.
This presentation is consistent with even the ERSPC findings that showed extending the timeline of the trial from 9 year to 12 years, announced earlier this year, showed the number dropping drastically for the number needed to be treated from 1 in 48 to 1 in 24 NNT to save a single life. The suggestion is to extend the trial to 15 or 20 years and the number should drop below 1 in as low as FOUR will reap benefit of screening and treatment.
Ralph this also challenges studies comparing active surveillance to treated arms in studies. The longer you extend the trials the more treatment appears to be beneficial. Trials on AS that show little difference at year ten are going to not be as positive for year 15 and 20. There will be continued debate until we have that data as to whether deciding to go with AS for say 7 years does no harm at year 15. We don't know we do not have that data.
The fact is if life expectancy is less than 10 years ~ the above findings means it can be quite safe to skip further screening or to go with AS if low risk prostate cancer is found in screening but doesn't apply unilaterally. What's more these numbers as posted in the USA and European studies on screening as released in the NEJM in 2009 would never apply to someone under the median age of diagnosis (67 years old) and has no other morbidities. And someone under 60 needs to understand that the data to get him to 80 does not exist in screening or in AS studies...
Advanced Prostate Cancer at age 44 (I am 48 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7
Da Vinci Surgery ~ 2/16/2007
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.
Post Edited (TC-LasVegas) : 5/19/2011 12:31:10 PM (GMT-6)