Sixty seconds on . . . prostate cancerBMJ 2018; 360 doi: https://doi.org/10.1136/bmj.k1385 (Published 27 March 2018) Cite this as: BMJ 2018;360:k1385
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Quoting from the USA's PIVOT trial on Prostate Cancer (PCa) is another example of conclusions being drawn from an outdated American study that is completely irrelevant so far as current UK urological practice is concerned. Worse still, it deflects GPs from giving balanced information to men quite rightly seeking PSA screening for PCa. Anyone wishing for an objective understanding of the flaws in PIVOT should read D'Amico's "Long-term Follow-up of PIVOT Argues for Immediate Treatment of Men With Unfavourable-Risk and Possibly High-Volume, Low-Risk Prostate Cancer".
So far as UK practice is concerned, those seeking to give an unbiased, objective, up to date information on screening should note the substantial falls in PCa mortality - over 40% - achieved in European screening programmes (eg Gothenburg and Rotterdam) compared with our dreadful annual mortality of over 11,800 men. Furthermore, what does deserve publicity are the highly acclaimed UK results from the PROMIS, PRECISION and ProtecT studies. These, together with the results of our 4th National Prostate Cancer Audit, have demonstrated that the "harms" of PCa screening - "over-diagnosis and over-treatment" - have been largely overcome in current UK clinical practice.
The audit shows that there is a widening gap between our high mortality/poor screening statistics and the excellent care now available to men lucky enough to have screen-detected, early, curable PCa. It also sadly confirms that over 50% of UK men still present with advanced and probably incurable PCa, 16% with metastases.
The conclusion has to be that in the absence of better options, application of PSA screening according to accepted national and international guidelines for properly informed men is the best way we can lower our unacceptable death rate for this thoroughly unpleasant cancer.
CM Booth, MBBS, FRCS,
Competing interests: No competing interests