“ Prostate cancer is one of the most common types of cancer that affects men. In the United States, the lifetime risk of being diagnosed with prostate cancer is approximately 11%, and the lifetime risk of dying of prostate cancer is 2.5%. Many men with prostate cancer never experience symptoms and, without screening, would never know they have the disease.”

This bottom-line statement is the result of a comprehensive review of medical evidence conducted by the U. S. Preventative Services Taskforce, based on extensive clinical trials of prostate screening.

After careful study and even considering the controversy they anticipated, the task force recommended against prostate-specific antigen (PSA) based screening for prostate cancer—their thought being that the potential benefit does not outweigh the expected harms.  

Dr. Richard Albin, the discoverer of PSA, stated in a 2010 New York Times editorial, “Screening men for prostate-specific antigen (PSA), the most commonly used tool for detecting prostate cancer, has become a "hugely expensive public health disaster." 

The benefits of screening based on large clinical trials have shown that, at best, PSA screening may help 1 man in 1,000 avoid death from prostate cancer after at least 10 years from when first diagnosed. Most likely, the number helped by the test is even smaller.  

Among the men who are not screened, about 5 out of every 1,000 men will still die from prostate cancer after 10 years of diagnosis. This translates to the fact that PSA screening for 1,000 men who might otherwise not be screened, four of five with a positive test will still die from prostate cancer after 10 years. This is even if they might have been screened. Therefore, screening only helps one in 1,000.

There are problems with the accuracy of the test—not so much that the number reported is incorrect but that there are false-positive results, over diagnosis, and over treatment with known almost unavoidable complications.  

Treatment is also full of controversy as more and more patients, physicians, and insurers are looking for evidence-based medicine as treatment options are considered. Standard radiation therapy currently is IMRT—intensity modulated radiation therapy—which uses a computer-guided X-ray approach to minimize damage to surrounding tissue and organs.  

Proton beam therapy is a newer and markedly more expensive option. Evidence-based medicine thus far has not shown any decrease in complications after one year of treatment and no difference in outcomes compared to the less expensive conventional treatment. A few insurance companies have refused to pay for the much more expensive modality. Medicare, the largest player in the market is still paying although reimbursement is falling as hospital billing costs for this modality are coming down. Medicare’s payments are somewhat proportional to the cost of producing a treatment. All this information is gleaned from a Wall Street Journal article.  

Nothing is straightforward anymore. Science progresses, the value equation (quality/cost = value) is still front and center. We still spend almost twice as much as other developed nations on healthcare; this has got to stop if we want to maintain our position as a leader in our globally competitive world.  

Stay tuned as the controversy remains unsettled … and unsettling.