Ioannidis is Wrong


For some time, I have been a follower of John P.A. Ioannidis, but I don’t agree with his recent analysis of PSA as a screening tool. He says that PSA is a failure and “largely useless— or even harmful—and therefore needs to be abandoned” He offers as evidence the recent USPSTF recommendation, which recommends against PSA screening altogether. Of course, PSA does have false positive problems and overtreatment is an issue. But …

An update from the ERSPC Trial states that “The European Randomized Study of Screening for Prostate Cancer has published its 11-year follow-up results (New England Journal of Medicine, March 15 2012). Once again, they demonstrate that screening does significantly reduce death from prostate cancer. The latest study confirms that a man who undergoes PSA testing will have his risk of dying from prostate cancer reduced by 29%.”

And one can listen to an oncologist, who had metastatic prostate cancer and recovered, and now treats prostate cancer patients.

The USPSTF is empowered by the Affordable Care Act. It’s clear that healthcare spending by the government must be reduced. There would be considerable cost savings for: 

  • the population of men over 50 in the US (or between 50 and 75) that would no longer receive a PSA test
  • the number of men that would have had an elevated PSA that would not receive a biopsy
  • the number men that would have been diagnosed with early prostate cancer via a PSA test / biopsy (~ 200,000 per year) that would not receive treatment (surgery or radiation)

Isn’t it likely that cost had a role in the USPSTF decision? But this is not covered in the Ioannidis article.


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