Screen time.

The prostate specific antigen (PSA) screening controversy was best crystallized on March 26, 2009, the date two large companion studies assessing efficacy of screening were published in the NEJM. (1) The U.S. PLCO study demonstrated, despite a 22% increase in prostate cancer detection, no reduction in 10-year mortality, while (2) the E.U. ERSPC study reported a 70% increase in detection associated with a 20% reduction in mortality. Bearing in mind the cost of over-treatment, the USPTF used the data generated on this side of the pond to support a 2012 official recommendation against PSA screening. But why were the results so disparate? That is the subject of this week’s published re-analysis of the combined PLCO and ERSPC data, and it’s generating big headlines. Turns out, the PLCO randomizations were more like suggestions, with 46% of those in the no-screening arm getting PSA draws anyway (you just can’t keep Americans away from an available medical test). When taking this into account, the two once-disparate studies now have remarkably similar outcomes: PSA screening in each approximates a 30% reduction in prostate cancer mortality. The USPTF will probably revise recommendations again soon, but for now we say keep the big picture in mind.