Re: PSA and Prostate Cancer Screening in the UK
PSA and Prostate Cancer Screening in the UK
We write with concern that the series of articles in the BMJ on 22/9/18 do not reflect the true situation on screening and early diagnosis of prostate cancer (PCa).
Whilst the Editorial on page 366 is balanced and factual, reporting the benefits of mpMRI, transperineal biopsy, active surveillance and new treatments that have dramatically reduced the harms of over-diagnosis and over-treatment, the BMJ’s “Editor’s Choice” is a brief, dogmatic, anti-screening conclusion that is dangerously misleading.
The “Systematic Review and Meta-analysis” on page 367 further misleads. The printed review is a synopsis of an extensive study in which the authors admit “The major limitations of this review stem from the included trials themselves”. This statement should have been published because only 5 trials have been included of which 2 (CAP and Lundgren) entailed only a single PSA which does not fulfil the criteria for an adequate screening programme. The third study, PLCO, was notoriously contaminated so its conclusions are not acceptable. The Quebec study is outdated and follow-up too short. Not included in the meta-analysis were the Gothenburg1 and Rotterdam2 studies showing 52% and 51% falls in PCa mortality whilst the latest study from California of over 400,000 men quotes a 64% fall in PCa mortality3!
None of the established screening programmes rely on GPs for delivery. We cannot reasonably expect GPs to reflect recent advances in specialist practice or be familiar with international guidelines on PCa screening when counselling men requesting a PSA test. However, we should expect the BMJ to provide balanced reporting on the benefits of screening which now appear to outweigh the harms. We should not forget that over 11,800 men die from this thoroughly unpleasant cancer and UK cure rates languish below most other advanced countries. On behalf of the National Federation of Prostate Cancer Support Groups (NFPCSG), we expect to see properly informed and balanced reporting in the future.
Frank Chinegwundoh MBE, Consultant Urologist, NFPCSG Clinical Advisory Board
Roger Wotton, Chairman, NFPCSG
1. Hugosson J et al. Scand J Urol 2018; 52(1): 27-37
2. European Urology. 2014; 65: 329-336
3. Alpert P F et al. Urology. 2018; 118: 119-126
Competing interests: No competing interests