Re: Treating prostate cancer
Chris Parker’s prominent BMJ editorial on prostate specific antigen (PSA) screening for prostate cancer (CaP) is highly misleading. It appears biased against screening by failing even to mention the 3 large, recently published, European studies showing a clear benefit from screening in reducing mortality from CaP. He then comes to a spurious conclusion in proposing that we should do far fewer prostatic biopsies to “cut the annual incidence of prostate biopsies in the UK by more than 10,000 and save time, costs and emotional distress associated with deciding how to treat low risk disease”. By curious coincidence 10,000 is the current UK annual death rate from CaP. This is the real 10,000 we should be concentrating on to reduce the actual time, higher costs, emotional and real physical distress of death from advanced, metastatic CaP.
Over the last 10 years the UK multi disciplinary approach in presenting treatment options to every new case of CaP has done much already to reduce the over treatment more characteristic of the North American practice examined in the PIVOT trial. Furthermore the UK has pioneered Informed Decision Making, the process that provides the information that allows men with early curable CaP to make an informed and reasoned decision on how they wish to be treated.
In the USA where PSA screening is the norm, the American Urological Association recommends that “the PSA test should be offered to well-informed men aged 40 years or older who have a life expectancy of at least 10 years”. By contrast UK men face a lottery and frequent discouragement when seeking CaP screening which can only worsen if GP’s read this unbalanced article - vested with the authority of a prestigious lead editorial - and take away the message that PSA screening is still not advisable. If so, we will continue to fail to detect early enough the dangerous CaPs that cause our unacceptable 10,000 deaths per annum and our death rate will not fall.
Chris Booth FRCS
CHAPS Men’s Health Charity
Competing Interest: none
1. Bartsch G et al, Tyrol Prostate Cancer - Demonstration Project BJUI 2008; 101: 809-816
2. Schroder FH et al Screening and Prostate Cancer Mortality in a Randomised European Study NEJM 2009; 360: 1320-1328
3. Hugosson J et al - Mortality from the Goteborg Randomised Population-based Prostate Cancer Screening Trial. Lancet Oncol. 2010; 11 (8): 725-732
4. Wilt TJ et al. The Prostate Cancer Intervention Versus Observation Trial. Con Clin Trials 2009; 30(1): 81-87
Competing interests: No competing interests