Imagine you have 1000 male employees. Your wellness vendor ignores the new guidelines on prostate testing and recommends that all these employees get the prostate (PSA) screen. Over a decade or so of screening, of those 1000 employees:
240 will be told they have a high PSA, suggestive of cancer, and need a biopsy;
In 140 the high PSA will have been a false positive, so undergoing biopsy has just problems - anxiety, pain, bleeding, infections including septicemia – but no benefit;
The biopsy will confirm the diagnosis of cancer in 100;
Of the 100 employees diagnosed with cancer, 80 will be treated with surgery and / or radiotherapy;
Of these 80 treated, 3 will benefit because in 77 treatment does not change the final result -- the cancer was slow-growing and would not kill, or was so aggressive that it’s fatal even after treatment;
Among the 80 treated, at least 60 will have major complications such as sexual impotence and/or urinary incontinence.
The benefits can be seen best in a graphic:
Considering the agony, cost, complications and modest benefits involved here, is this a screen you want to encourage? Many vendors continue to think so.
We have rewritten our PSA quiz questions accordingly. We teach employees to bring this write-up to their doctor, and discuss with their doctor whether a PSA test is warranted in their particular situations, weighing the risks and the benefits.
As of this writing, this answer is awaiting the review of our Harvard Medical School colleagues, and should be ready for inclusion in our quizzes by the end of the month.