The fact you point out: that actual deaths due to prostate cancer in the
US have declined since PSA testing became common in the early 90s is one
of the arguments for believing that such testing is effective and saves
lives.  Thus, it is relevant to compare the US today with other
countries which haven't used routine PSA testing or with the  US before
testing was common.

Unfortunately, it is not quite that simple.   First, there may be other
unknown factors which have led to the decline in deaths due to prostate
cancer in the US during the period of PSA testing.   Second, PSA tesing
and the resulting aggressive treatment has some known undesirable side
effects.  A certain number of men receiving such treatment will suffer
serious quality of life problems, and if they in fact did not need
treatment because their cancers were benign, that is a cost to consider.

The proper way to test the hypothesis that PSA testing is effective at
saving lives is to do a randomized prospective study.   There are such
studies underway, and the results should be forthcoming down the line.
 Skeptics about PSA testing, of which there are many, including
reputable medical scientists, argue that, since aggressive early
treatment involves a certain amount of undesirable side effects, we
should wait until the results from such studies are available before
recommending PSA testing for the entire population.  Most authorities
agree that PSA testing is advisable for certain subpopulations and
undesirable for others.  For example, even Walsh recommends AGAINST PSA
testing for men past a certain age, who would not be expected to
benefit.   You really need something like a 10-15 year expected lifetime
in order that the benefits of early treatment exceed the risks.

It is also fairly clear that routine PSA testing inflates the number of
cases diagnosed, by diagnosing some cancers which never needed
treatment, and diagnoses cases something like 5 years earlier than
otherwise would be the case.  For both these reasons 5 year  survival
rates will look much better.  So looking at 5 year survival rates will
inflate the significance of PSA testing and aggressive treatment of
early prostate cancers.  The recent statements made by Giuliani
concerned survival rates, so that is why this is relevant.  (And even
that calculations was done in a stupid manner.)

Note by the way that one of the other factors which might explain the
difference in number of deaths due to PC between the US and other
countries is that treatment, once PS is detected, is superior in the US.
  If that is true, it might mean that PSA tesing is not really an
effective way to deal with prostate cancer, and that death rates would
have declined just as much without such testing.  Personally,  I don't
think there is much evidence that such is the case.   I think that the
real difference is that PSA testing is common in the US and, until
recently, was not common in those countries.

I also think this has little to do with how medical care is paid for.
Both in the US and in the UK, there are outside agencies which determine
to some extent what types of care will be paid for.  In the UK, it is
the NHS.  In the US it is HMOs and insurance companies.   You can be
sure, for example, that should the randomized prospective studies show
no significant advantage for PSA testing, that third party payers will
stop paying for it.   Of course men can always pay for it out of pocket,
but they can do that under any system.  And in all the countries under
discussion, people who are wealthy enough to buy premium insurace or
just pay for it out of pocket will be able to seek whatever tests,
treatments, etc. that they deem appropriate.

Let me repeat.  If you believe PSA testing, followed by early treatment
in appropriate cases, is effective, and you are not just out for
yourself, you should support universal health insurance so that all men
will have access to it, not just veterans and men over 65.

I think that the last conclusion is not correct.   It seems more likely
that many physicians in the UK, like the great bulk of US physicians 15
years ago, are still not convinced that PSA testing ultimately saves
lives.  Also, there are still many US physicians who have the same
philosophy.  Consider for the example the following quote from the web
page of the National Cancer Institute of the US government.

"Your doctor can check you for prostate cancer before you have any
symptoms.
Screening  can help doctors find and treat cancer early. But studies so far
have not shown that screening tests reduce the number of deaths from
prostate cancer. You may want to talk with your doctor about the possible
benefits and harms of being screened. The decision to be screened,
like many other medical decisions, is a personal one. You should decide
after learning the pros and cons of screening."

See also the entries about prostate cancer at the web page of the
American Academy of Family Physicians

familydoctor.org/online/famdocen/home.html

which make similar recommendations.

On the other hand, attitudes about PSA testing have been changing in the
US in recent years.  Consider for example the advice at

www.patient.co.uk/showdoc/23069165/

It is  very similar to what a great many US physicians think.  I suspect
that 10 years from now PSA testing will be as common in the UK as in the
US and 5 year survival rates will be very very similar.

In any case, one thing about the US is very clear.  If you don't have
medical insurance,  and you get prostate cancer,  the chances of it
being detected and treated early are pretty small.  More likely, your
cancer will be discovered after it has progressed far enough to block
urination or else metastasized to bone.

So any man who is concerned about prostate cancer and not just out for
himself should be in favor of universal access to PSA testing for men in
the US and for appropriate treatment when needed.  The simplest way to
accomplish this is through universal health insurance.  I wonder what
Giuliani would say about that.