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Counting what the blood test did to a country. In the twenty years after PSA testing began in the United States, an extra 1.3 million men were diagnosed with prostate cancer and about a million were definitively treated, for a benefit that on the most generous assumption reached one man in twenty of them.
H. Gilbert Welch and Peter Albertsen took age-specific incidence and initial treatment from the Surveillance, Epidemiology, and End Results programme and United States Census population estimates, and computed the excess number of men diagnosed and treated in each year after 1986, the year before prostate-specific antigen screening was introduced.
The age pattern is the part usually left out of the summary. Relative incidence in 2005 against 1986 was 0.56 in men aged 80 and over, and 7.23 in men under 50: the test moved diagnosis down the age distribution, into men with decades of life ahead of them and the most to lose from incontinence and erectile dysfunction. The authors then made the most favourable possible assumption, that the entire fall in prostate cancer mortality over the period was caused by screening, and still found that more than 20 men had to be diagnosed for each one who benefited.
The number that anchors the overdiagnosis argument in prostate cancer: over a million American men treated for a cancer that, for most of them, was never going to surface. It is the reason active surveillance exists as a formal pathway and the reason magnetic resonance imaging was brought in front of the biopsy.
The honest state of the overdiagnosis question. Prostate cancer is common in the prostates of men who die of something else, screening finds a proportion of it, and how much of that is harm depends on what is done next. The fix is not a better estimate but fewer treatments for the cancers that do not need them.
The reference for anyone quoting an overdiagnosis figure in prostate cancer. The honest statement is a range with its definition and its population attached, and the paper is the reason this page does not print one number.
The origin of the blood test that defines how prostate cancer is found, monitored and declared to have recurred. Its strength was always monitoring a known cancer; the problems began when the same test was used to look for cancer in men who had no symptoms.
Shares Lead time, and lead-time bias, Overtreatment, Overdiagnosis, PSA (prostate-specific antigen) and the tag prostate-evidence.
Shares Lead time and overdiagnosis in prostate-specific antigen screening: importance of methods and context, Overdiagnosis and overtreatment of prostate cancer, Lead time, and lead-time bias, Overtreatment and the tag prostate-evidence.
Shares Prostate-specific antigen as a serum marker for adenocarcinoma of the prostate, Lead time, and lead-time bias, PSA (prostate-specific antigen), Localised prostate cancer, very low and low risk and the tag prostate-evidence.
Shares Long-term follow-up of a large active surveillance cohort of patients with prostate cancer (Sunnybrook), Overtreatment, Overdiagnosis, PSA (prostate-specific antigen) and the tag prostate-evidence.
Shares Lead time and overdiagnosis in prostate-specific antigen screening: importance of methods and context, Lead time, and lead-time bias, Overdiagnosis, PSA (prostate-specific antigen) and the tag prostate-evidence.
Shares Overdiagnosis and overtreatment of prostate cancer, Overtreatment, Overdiagnosis, PSA (prostate-specific antigen) and the tag prostate-evidence.
Shares Lead time, and lead-time bias, PSA (prostate-specific antigen), Localised prostate cancer, very low and low risk, Screening and the tag prostate-evidence.
Shares Overtreatment, Overdiagnosis, Overdiagnosis and false alarms, Prostate cancer roadmap: from Huggins and the discovery that a cancer can depend on a hormone, through the PSA epidemic and what it cost, the androgen receptor drugs, the DNA repair subset and PSMA, to a 2032 registry watch and the tag prostate-evidence.