Public service announcement.

Apparently there are still haters of the ERSPC study that established a prostate cancer mortality benefit with the use of PSA screening. Some argue there was no control for various treatments received for different risk stratifications once diagnosed. So, in fact, it may have been variations in treatment that were responsible for the difference in survival. Others make a compelling argument that this was a population-based study with the goal of determining the impact of PSA screening on real-world (i.e., non-controlled) treatment outcomes. So, in other words, who cares? In any case, this secondary analysis estimated the cancer mortality that would have been observed in the screening arm if similar primary treatments had been applied with identical outcomes (per clinical risk) to that in the control arm. The difference in rate of estimated deaths per this sophisticated model and actual deaths recorded in the screening arm was a whopping 0.05% (i.e., non-contributory). TBL: The more we scrutinize PSA screening studies, the more they point towards a population-based survival advantage with the routine use of age-based PSA screening. | Carlsson, Eur Urol 2019