Now here’s a new perspective on the value of widespread prostate cancer screening from one of the founders of Prostate Cancer Awareness Week — Dr. David Crawford of the University of Colorado Health Science Center in Denver, CO (who is also the Chairman of the Prostate Conditions Education Council):
The utility of screening and diagnosing prostate cancer clearly deteriorates with increasing age. In a population over age 65, approximately 200 men need to be treated for at least 12 years before 1 prostate cancer death is prevented.
If this statement is correct, then the idea that we should be screening men of ≥ 65 years of age for risk of prostate cancer would appear to be, at best, dubious.
As regular readers will be aware, The “New” Prostate Cancer InfoLink has long questioned the value of mass, population-based screening for prostate cancer (as contrasted with thoughtful, individual, risk-based testing). The consequences of treating 200 men for 12 years (2,400 life-years of treatment) to actually “save” a single life implies massive unnecessary risk for complications of treatment among 199 men who are going to receive no benefit from such treatment … and of course we have no good way to tell which of the 200 men so treated are likely to benefit. Is this even ethical?
We would note that, in the early and mid 1990s, Dr. Crawford was among the strongest of advocates for mass screening with the PSA test. The quotation above would appear to imply that he has had a significant change of heart. Perhaps this really does signal the beginnings of a sea-change within the urology community.