Over the last few days the media has been full of debate about the most recent, contradictory studies that have been released about the efficacy of the PSA as a diagnostic tool for prostate cancer. Normally, I would not write about this issue in this blog since those of us with recurrences and advanced prostate cancer disease have already gone beyond the issues in this debate (other than our concern for our brothers and sons).
However, it is such an important matter and has become so controversial I can not ignore the issue. There are significant flaws in both the European study and the American study.
1- Both studies released results too early as I believe we will not see differences in mortality rates between screened and not screened groups until well after 10 years. The mortality rate for prostate cancer in the first ten years after diagnosis is not high, but it does increase after that time period.
2- Consistent with my on-going concern the media and researchers have confused two different issues, screening and treatment. The anti-psa advocates claim that screening causes terrible morbidity issues. Screening does not cause morbidity issues, treatment does. There is no question that in the United States we do over treat thus causing the unnecessary degradation in the quality of life (QOL). Doctors, the diagnosed and their families need to sort out when treatment is appropriate. The diagnosis of prostate cancer does not mean that treatment is necessary. Better advise from diagnosing physicians, mandatory second opinions prior to treatment and involvement in support groups to assist a newly diagnosed man to make treatment (or no treatment) decisions needs to become the normal protocol.
3- The samples in both of these studies were contaminated. In the American study the no screening control arm did not prevent any of this sample from being screened. In fact, I believe that as much as 40% of this control sample did actually have PSA tests on their own!
The European study was actually a conglomeration of seven separate studies all using slightly different experimental criteria. I submit that neither of these trials can be assumed to have generate valid information.
I have posted a link from the New England Journal of Medicine to a very interesting, easy to understand video conversation about these two studies and the controversy: Click here
Joel T Nowak MA, MSW