Prostate Cancer Test and The Survival Rates of Those Who Had Surgery for Prostate Cancer

                                                                                         

Efficacy of the PSA test
Approximately one man in six will be diagnosed with prostate cancer during his lifetime, and over 200,000 men in the US are diagnosed with prostate cancer annually. Since the widespread adoption of PSA testing, about 60-70% of men at risk in the US have had a blood test for prostate cancer. As a result, prostate cancer death rates have decreased, yet only slightly. Thirty thousand men still die each year from this disease.
PSA testing fails to identify a small but significant proportion of aggressive cancers, and only about 30% of men with a ¡°positive¡± PSA have a positive biopsy. Additionally, of men who were treated for prostate cancer, about 25% require additional treatment, presumably due to disease recurrence. Also of concern is the growing evidence that treatments may not be necessary. Very long-term studies from the US and Europe, following men with prostate cancer, have found that some tumors do not progress over time. In these individuals, prostate cancer treatment is unnecessary, if not harmful. As these men do not benefit from treatment, they are actually at risk of treatment-related side effects and complications.
There is no difference in the survival rates of those who had surgery for prostate cancer and controls who did not. This follows earlier reports that radical surgery for prostate cancer also tends to spread the disease. After 23 years, since the first randomized clinical trials for any type of cancer, it has been found that there is no difference in the survival rates of those prostate cancer patients who had surgery and controls who did not. Those who had surgery suffered increased morbidity effects such as impotence or incontinence.
Interpreting statistics for prostate cancer intervention. A recent paper reporting on the result of a randomized trial comparing Radical Prostatectomy with Watchful Waiting for prostate cancer appeared to contain serious flaws. For example, it used an ambiguous definition of ¡°death from prostate cancer¡± and claimed a 50% reduction in mortality using surgery as compared with watchful waiting. The reduction in overall mortality was not significant.
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Similarly, a paper reporting on results of a randomized trials comparing mortality after PSA screening with an unscreened control group also contained serious flaws. Although its authors claimed a 69% reduction of deaths due to screening, they arrived at this figure by comparing only 23% of those invited for screening in the Invited group with 93.5% of those in the Uninvited group. This was a meaningless comparison in randomized trials.

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