Intended for healthcare professionals

Rapid response to:

Press Press

The PSA storm

BMJ 2002; 324 doi: (Published 16 February 2002) Cite this as: BMJ 2002;324:431

Rapid Response:

The PSA storm

The PSA Storm

I applaud the courage of Gavin Yamey and Michael Wilkes who dared to
say, “the Emperor has no clothes”. The predictable tidal wave of
invitations to rest upon their own scalpels only serves to confirm how
American vested interests fear their simple truth. The fact is that we do
not know whether PSA testing does more harm or good.

Prostate cancer screening is creeping in by default because no one
has cared to stop it. The entrance fee (PSA-test) is cheap but worth
little more than six free numbers in a lucky draw mail-shot. The final
cost to the patient (and the NHS) can be colossal. Tickets for the
Colonoscopy-show are much more expensive but the rest of the programme is
relatively cheap and effective, and likely to have a happy ending. PSA
screening is a high budget epic that may yet flop. Colon cancer screening
is Oscar material but frozen on storyboard by inadequate resources.

Medico-political woolly-thinkers and urological Holy-grail-spotters
seem to have side-stepped the hard scientific and financial questions and
allowed, or encouraged, the public to select prostate cancer rather than
colon cancer screening. In the UK, suffrage-based medicine simply allows
such practices to flourish. In the USA, PSA-testing is the raw material
for a major dollar-rich industry producing thousands of impotent and
almost-continent men every year. Iconoclasts like Yamey and Wilkes and
fellow urosceptics may take cover.

But PSA screening is not the only regal streaker. Dare I mention MRSA
swabbing of patients but not of staff ? – I guess not!

Robin Brown
cholesterol 6.5, PSA unknown, MRSA +ve (probably)


Surgical directorate,
Daisy Hill Hospital, Newry. N. Ireland

Yamey G, Wilkes M. The PSA Storm. BMJ 2002; 324: 431. (16 February).

Competing interests: No competing interests

19 February 2002
Robin Brown
Consultant surgeon
Daisy Hill Hospital, 5 Hospital Rd, Newry, Co. Down, N. Ireland BT35 8DR