Authors’ reply to KoleBMJ 2016; 354 doi: https://doi.org/10.1136/bmj.i3795 (Published 12 July 2016) Cite this as: BMJ 2016;354:i3795
- Ian E Haines, associate professor1 2,
- Richard J Ablin, professor3 4,
- George L Gabor Miklos, founder5
- 1Melbourne Oncology Group, Cabrini Medical Centre, Malvern 3144, Australia
- 2AMREP Department of Medicine, Monash University, Australia
- 3Department of Pathology, University of Arizona College of Medicine, Tucson, AZ, USA
- 4Arizona Cancer Center and BIO5 Institute, Tucson, AZ, USA
- 5Atomic Oncology, Newport, NSW 2106, Australia
We thank Kole for his response to our article calling for release of data underpinning Public Health England’s (PHE) advice to GPs and men over 50 on PSA screening.1 2 He notes PHE’s emphasis on current uncertainty and why this data release is vital.
PHE’s first point, that “you are more likely to die of prostate cancer and/or to experience the complications of advanced incurable prostate cancer if you do not have PSA screening,” is correct according to incomplete analysis by the ERSPC study of incompletely published data.
However, this trial seems to contain large biases that would favour screening. Furthermore, absolute differences in prostate cancer specific mortality, even without correction for apparent biases, were very small and showed a reduction of prostate specific mortality of only 0.11 per 1000 person years—despite the headline figure of a 21% reduction in relative risk, as Kole highlights. To mention the large relative risk reduction of dying from prostate cancer, rather than concentrate on the very small absolute mortality reduction, is misleading for doctors and patients.
A full data release for independent analysis is urgent. It is unreasonable to withhold independently verified details on the men in the trial in each arm who died, with columns for: (a) stage and risk group (low, intermediate, or high); and (b) treatment received out of active surveillance and watchful waiting, androgen deprivation therapy alone, and radical treatment with surgery or radiation.
Results from the three arm ProtecT study are expected soon and will influence decision making in men about PSA screening and treatment for early stage prostate cancer.
We agree with Kole and urge doctors and professional medical groups everywhere, as well as government public health groups such as PHE, to increase pressure on ERSPC to release its data for independent analysis.
Competing interests: None declared.