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The PSA storm

BMJ 2002; 324 doi: (Published 16 February 2002) Cite this as: BMJ 2002;324:431
  1. Gavin Yamey, deputy editor,
  2. Michael Wilkes, editor
  1. Western Journal of Medicine, Oakland, California

    Questioning cancer screening can be a risky business in America

    Many people in the United States think that screening is a panacea, a way of warding off disease and staying healthy—perhaps forever. Those who question this fairytale view, as we recently discovered, are considered traitors, or even murderers.

    On 18 December 2001, the San Francisco Chronicle published an article in its sports section about Dusty Baker, manager of the Giants, the city's baseball team. Baker had just had surgery for prostate cancer, which was diagnosed after a “routine” blood test for prostate specific antigen (PSA).

    A urologist was quoted as saying that PSA tests had made “a world of difference” in fighting prostate cancer because “doctors have been able to catch the tumors early before they have spread.” Baker's doctors had chosen surgery over other treatments, said the article, since surgery was “the surest way to prevent any return of the disease.”

    Thousands of men would have seen this article and it would have left them with an extremely optimistic picture of the benefits of PSA testing and of prostate surgery.

    We …

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