Prostate cancer screening – the Goteborg study

In the interest of full disclosure, I have actually been to Goteborg, Sweden (aka Gothenberg, and pronounced “YO-te-bory” by locals) to ski. But that is not the reason for writing about this fine city. The Cancer Letter from this week highlights the prostate cancer screening study from this city. 20,000 men were enrolled in 1994 and half were screened with PSA every 2 years. The cutoff was a low one, PSA 2.5, and 90% of the men “failing” the test were biopsied. The results were strikingly positive, ultimately cutting prostate cancer mortality by almost half over 14 years. In the critique, there are numerous objections to getting overly excited about a single study. These include the high rate of prostate cancer in Sweden (screening more likely to be helpful than in a location where the incidence is lower), and the fact that this was but one of the trial centers included in the marginally positive European Randomized Study of Screening for Prostate Cancer (ERSPC). The Cancer Letter points out: “Overall, 293 men needed to be invited to screening and 12 diagnosed to save one life. This is spectacularly better than the overall ERSPC, where 1,410 men needed to be screened to detect 48 cases of prostate cancer and prevent one death.” However, others in the article point out that there are still marked problems with overdiagnosis and overtreatment with all of the co-morbidities. Clearly, we need better tests to get out of this conundrum, and hopefully there will soon be some better gene profiling methodology that can help. Until then, here are my recommendations: Get a PSA and DRE at age 50. If it is less than one, you have no family history, you are not an African American, then don’t get another one for 3 years. Stop getting screened when you reach 70 unless you can run a marathon or your parents both lived into their 90’s. If you have a positive family history (this might apply to the male relatives of many readers of this blog), start getting screened at age 40 and continue until you are 70, or maybe even older. I think this makes the most sense given what we currently know.

4 Comments

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4 responses to “Prostate cancer screening – the Goteborg study

  1. Ray Baker

    Your recommendations make sense to me, at least it gives a framework that men can use.

    PS I fall into the 70s and can walk a mean marathon and had parents into their 90s.
    Ray

  2. Thanks for the comment, Ray. For you and your similarly genetically blessed colleagues, I suppose the question is when to stop after 70. My experience in taking care of older men is that many more now live into their 80’s, but relatively few make it into their 90’s. Those who do, are often facing significant challenges with their activities of everyday living. Perhaps it would be best to stop screening arbitrarily at age 80 for these individuals, since one of the major issues for octagenerians is how to keep doctors of all sorts from doing more harm than good. In my experience it is the gerentologists who are best at this, not the medical oncologists or urologists.

  3. Bob Lederer

    Mike, I appreciate your sending this and your recommendations. My brother and I both have two sons so I could send on your recommendations to them. (all are over 40)

  4. Pingback: More on the “no free ride” reality | prost8blog

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