This report reminds us that, at the population level, the value of PSA screening depends substantially on how men weigh the downstream benefits and harms of screening. One puzzling aspect of this theoretical analysis is its conclusion that screening would prevent 9 prostate cancer–related deaths per 1000 men; this benefit is ninefold larger than what actually has been demonstrated thus far in the ERSPC (1 death prevented per 1000 men screened, after mean follow-up of 11 years). Because this model assumes annual screening starting at age 55 and lifetime follow-up (whereas the ERSPC screened only every 4 years and started screening at various ages), the model's larger mortality benefit is plausible. However, the huge difference between the estimated benefit and actual ERSPC results is surprising. The authors indirectly acknowledge this issue in their cautious conclusion: "Longer follow-up data from both the ERSPC and quality-of-life analyses are essential before universal recommendations regarding screening can be made."
Journal Watch © 2012 Massachusetts Medical Society