"The challenge of ecologic data is that it is impossible to reliably separate out the relative effects of any changes in screening, diagnosis, or treatment practices (or fundamental changes in the underlying risk of developing or dying of the disease in the population due to a multiplicity of other causes) that may have been occurring simultaneously over a given time period. "
This is pure dissembling BS designed to justify rationing.
Here is a more measured -- and patient-centered -- approach by urologist William Catalona:
The past half decade has seen a striking reduction of prostate cancer mortality rates in the US and other countries. The decrease has been ascribed, at least in part, to early diagnosis combined with more effective treatment, although there is no proof of a causal relationship.
Nevertheless, to the extent that early detection and effective treatment do reduce prostate cancer mortality and morbidity rates, PSA screening is clearly beneficial to many patients.
Some argue that PSA screening is not beneficial for all men screened because not every prostate cancer patient benefits from early diagnosis and treatment. Some tumors might never be life threatening and rare ones are incurable by the time the PSA level becomes elevated.
However, all available evidence suggests that PSA screening largely detects cancers that have features of clinically important cancers that are destined to cause suffering and death if untreated while they are still curable.
Some also argue that PSA screening is not beneficial to men who are never affected with prostate cancer. PSA screening does provide a feeling of well being in men who have persistently normal results, and even though a normal value can be misleading, with serial screening, PSA eventually reveals the cancer.