Long term outcomes from PSA screening
The Cluster Randomised Trial of PSA Testing for Prostate Cancer (CAP) study has just reported 15-year mortality findings. Between 2002 and 2009 over 400 000 men aged 50-69 years in England and Wales were either sent an invitation for prostate cancer screening or had no intervention. Those who took up the offer of screening were referred on for diagnostic testing if their PSA level was ≥3 ng/mL. Those offered screening had a 0.69% risk of dying from prostate cancer after 15 years, compared with 0.78% in those not offered screening. There was no difference in all-cause mortality between the two groups. However, it’s hard to know how these findings relate to current practice. Over the 20 years or more since this study started much has changed: referral thresholds, diagnostic techniques, and treatment options.
If only there was a study of prostate cancer screening aimed at identifying high grade prostate cancers while reducing the risk of overdiagnosis.
JAMA doi:10.1001/jama.2024.4011
Improving prostate cancer screening accuracy
And, as if by magic, here’s a preliminary report from a trial of prostate cancer screening designed to have a higher specificity for diagnosing high grade prostate cancer while reducing overdiagnosis. In this study, set in Finland, 15 201 men were sent screening invitations. Around half of them took up the invitation, and 9.7% of them had a PSA value ≥3 ng/mL, so went on to have a kallikrein panel test, consisting of total PSA, free PSA, intact PSA, and human kallikrein. This reduced the number needing further testing to 6.8%, and, after magnetic resonance imaging, only 2.7% of those who took up the screening invite were referred for a biopsy. Of those who had a biopsy, 65% were diagnosed with prostate cancer, mostly high grade cancer (113 high grade, 22 low grade). So far, so good, but whether this approach makes a difference to mortality from prostate cancer remains unknown.
JAMA doi:10.1001/jama.2024.3841
Inappropriate diagnosis of pneumonia
Back in my hospital days, it wasn’t unusual for someone to be clerked in and started on treatment for community acquired pneumonia (CAP) only for the chest x ray (that at 2 am had definitely looked as though it had some patchy consolidation on it) to be later reported as normal. The diagnosis would usually get revised, but—often in the haste to get people home—not always. A retrospective review of patient records found that 2079 (12%) of 17 290 patients treated for pneumonia in hospitals in Michigan were inappropriately diagnosed with CAP over a three year period. Most of these (74%) were judged to be due to a lack of radiographic evidence of pneumonia, and under a quarter were due to fewer than two signs or symptoms of pneumonia being documented.
JAMA Intern Med doi:10.1001/jamainternmed.2024.0077
Traffic fatalities eclipse sun and moon event
In ancient Greece a solar eclipse led to peace between the Medes and the Lydians, who stopped battle and put down their weapons in response to the celestial omen. Before reading a research letter about fatal traffic risks related to a total solar eclipse in the US, I wondered if evidence had come to light of people suddenly respecting speed limits and lane etiquette, inspired by the sun and moon’s example of the power of cooperation. It seems not, as the researchers found an increase in fatal crashes during the three days around the eclipse in 2017 (10.3 per hour versus 7.9 per hour during control days). Possible explanations given by the authors include “speeding to arrive on time, driver distraction by a rare celestial event, drug- or alcohol-induced impairment from eclipse-related celebrations, and eclipse viewing from unsafe roadside locations.”
JAMA Intern Med doi:10.1001/jamainternmed.2023.5234
Quiz burdens
Public health policy makers will be busy digesting the data from the latest Global Burden of Diseases, Injuries, and Risk Factors Study, which estimates causes of death and years of life lost across 204 countries in 2021. For the rest of us, it’s a chance to brush up on our knowledge for quiz rounds when the topic is health and everyone looks at you, expecting you to know all the answers. What were the leading five causes of age-standardised deaths globally in 2021 in descending order? (Ischaemic heart disease, covid-19, stroke, chronic obstructive pulmonary disease, and lower respiratory infections.) What was the change in global life expectancy between 2019 and 2021? (A net reduction of 1.6 years.) Which super-region saw the highest age-standardised deaths from covid-19 in 2021? (Sub-Saharan Africa.) How many collaborators are listed on the publication? (2001.)
Lancet doi:10.1016/S0140-6736(24)00367-2