The change in recommendation around prostate cancer screening about ten years ago is hard to comprehend. Up until that time, there was a steady decrease in the rate of prostate CA death as treatments were refined. Someone somewhere thought the number of cases treated to save one life were too high, one assumes.

Prostate cancer is a funny animal. We have tried to grade the aggressiveness of biopsy samples with a Gleeson score to pick out the dangerous ones. It has really not been that successful unless the scores are at the extremes. Most biopsies return a score of 6-7, looking not only at the cell morphology but also the tissue architecture as well.

So what are the odds of a Gleeson 6-7 being an aggressive cancer or a cancer you will die with and not of? Nobody knows. It would be unethical to randomize cancer patients to that study without letting them choose whether to treat or not.

From my personal perspective, a 1 in 10 risk is unacceptable, considering the lingering and painful death that comes with aggressive prostate cancer. 1 in 20, still unacceptable to me. 1 in 50, maybe, but wouldn't you feel especially bad if you got the aggressive cancer?

What we do know is that prostate cancer death rate has fallen steadily since the 50's. I recommended annual PSA and DRE to any that asked for my opinion.

fd