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Does Prostate Cancer Screening Reduce Mortality Rates?
Date:4/14/2011

can lead you to make incorrect conclusions.  While both studies are based on the same premise, their outcomes are very different due to variances in testing procedures and the number of men studied."

Dr. Samadi goes into detail about some of the factors that call the new study's validity into question, citing the lack of PSA (Prostate-Specific Antigen) testing in the early stages of the BMJ trial as the largest concern.  PSA testing was not included in the BMJ study until 1993, 6 years after its start. Prior to that, only digital rectal exams were used for screening, which are not nearly as accurate a test as PSA.  Samadi said, "A concern I have with how this study was conducted is that PSA levels were not monitored for the first six years.  Early screening was based entirely on digital rectal exams, which we now know are not an accurate method for detecting prostate cancer when used alone.  The larger study published in the NEJM showed that regular PSA testing improved prostate cancer detection and outcomes, highlighting a shortcoming of the methods used in the BMJ study."

The BMJ study spans 20 years, 14 years following the introduction of PSA, compared to an average of 9 years in the NEJM study.  The benefit of the longer length of follow-up in the BMJ study, however, may be outweighed by the small number of men actually diagnosed with prostate cancer by screening.  Only 43 men in the BMJ study were diagnosed with screening, compared with 6000 men in the NEJM study.  This difference may explain the discrepancy in outcomes between the studies.
Additionally, improvements in prostate cancer treatment over the study period may have underestimated the value of early detection.  "We need to keep in mind that a lot has changed in cancer treatment over the course of 20 years, especially with the introduction of

SOURCE Smart-surgery.com
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