Reconsidering Prostate Cancer Mortality — The Future of PSA Screening | NEJM

Reconsidering Prostate Cancer Mortality — The Future of PSA Screening | NEJM: Medicine and Society
Reconsidering Prostate Cancer Mortality — The Future of PSA Screening
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H. Gilbert Welch, M.D., M.P.H., and Peter C. Albertsen, M.D.

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From its peak in the early 1990s, U.S. mortality due to prostate cancer has decreased from 39 per 100,000 men to 19 per 100,000 men — essentially by half. Although everyone agrees that this reduction is good news, there is considerable disagreement about why it happened. The controversy has profound implications for the future of prostate-specific antigen (PSA) screening.
Figure 1. Prostate Cancer Mortality in the United States, 1950–2016.

A long-term perspective on trends in cancer-specific mortality among patients with three common causes of cancer-related deaths since 1950 is provided in Figure 1A. The substantial rise and fall in the largest component of cancer-related mortality, lung cancer mortality, reflects the rise and fall in rates of cigarette smoking decades earlier. In contrast, breast cancer mortality was remarkably stable until 1990 and then began to fall. Prostate cancer mortality was similarly stable until 1970 and als