Sharing the Decision Slide Set: Slide 22

Talking Points and Text Description of Slide

Slide 22 — What Happens to Prostate Cancer Mortality Rates in the U.K., Where PSA Screening Is Rare?

Talking Points

It would be easier to conclude that PSA screening caused the decrease in U.S. mortality if studies consistently found that mortality reductions occurred primarily in places where there was widespread PSA screening and not in places where there was little or no screening.

Research comparing trends in prostate cancer mortality rates among countries shows inconsistencies in the relationship between national mortality trends and the uptake of PSA screening.

This slide shows changes in prostate cancer mortality in the United Kingdom, where PSA screening is uncommon. Although U.K. mortality rates were substantially higher than U.S. mortality rates from the 1970s through the 1990s, mortality trends were similar to those in the U.S. in showing an increase during the 1980s and a decline in the 1990s.

Also, a recent study comparing screening practices and mortality in two U.S. regions found that PSA screening began earlier and was more common in the Seattle area than in Connecticut, and that aggressive treatment was more common in Seattle than in Connecticut. However, these differences in the practice of PSA screening were not related to differences in prostate cancer mortality over an 11-year follow-up period. Mortality was basically the same in both regions.

These studies are not definitive but they illustrate the complexity in determining relationships between PSA screening use and trends in prostate cancer mortality.

For all these reasons, it is difficult to say whether PSA screening has led to the reduction in U.S. prostate cancer mortality.

Sources: Oliver et al., 2001; Lu-Yao et al., 2002.

Text Description of Slide

Line graph shows trend of prostate cancer mortality rate per 100,000 in the United Kingdom from 1979 to 1997 where PSA screening is rare.