Intended for healthcare professionals


Screening without evidence of efficacy

BMJ 2004; 328 doi: (Published 05 February 2004) Cite this as: BMJ 2004;328:301

PSA Screening: Medicolegal issues

Theoretically, a patient with a PSA screen detected prostate cancer can sue his General practitioner for psychological distress if he has not been properly counseled about the pros and cons of PSA screening. But the case would hinge on whether the PSA test was done as a screening or diagnostic test. Benign enlargement of prostrate due to BPH and lower urinary tract symptoms (LUTS) are present in almost all elderly men and the PSA test could have been done as part of the diagnostic workup.

The high incidence of LUTS in elderly also means that nearly all prostate cancer patients have a history of LUTS ranging from months to years. As the awareness of prostate cancer increases in men, it is also possible that these prostate cancer patients might feel that there has been delay in diagnosis and this has consequentially affected their prognosis. While we wait for randomised evidence, I would be very interested to hear the views of general practitioners about PSA screening.

If one accepts that the primary purpose of an editorial or commentary is to inform, educate, stimulate discussion and change clinical practice, then it would be useful to know what the readers think about an article. ‘Rapid responses’ in BMJ serves this purpose very well only if someone disagrees with a viewpoint or has something important to add (and then has the time to sit-down and draft a reply).

The practice of medicine in real world is not always based on gold- standard double-blind randomised trial evidence. Sometimes it is based on what our colleagues around the country do and what is considered to be acceptable. So it would be very helpful if there is scope for a ‘reality’ television style yes /no or agree/disagree response facility to certain articles in BMJ. I suppose some critics might say that BMJ is being ‘sexed up’ to appeal to the lowest common denominator but I feel this facility would make the BMJ more relevant to people at the ‘coal face’.

Competing interests: I treat prostate cancer patients

Competing interests: No competing interests

03 March 2004
Santhanam Sundar
Consultant Oncologist
Dept of Oncology, Nottingham City Hospital, NG5 1PB.