publication date: Oct. 10, 2014

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By Andrew Vickers

I consider myself a prostate cancer screening skeptic. For example, in the title of the grand rounds lecture I have given for many years, I describe PSA as a “public health fiasco.”

I have also gone on the record to state: “PSA testing as it is commonly practiced in the U.S. is indefensible.”

But there are two types of PSA skeptics. Those in the “fix it” camp, myself included, believe that PSA screening, as it has been implemented in the U.S., may well have done more harm than good, because of indiscriminate screening in older men and overtreatment of low-risk disease.

More rational use of PSA could result in more good than harm.

PSA skeptics in the “forget it” camp believe, conversely, that PSA screening is inherently flawed, will never be of net benefit and should be abandoned.

It turns out that “forget it” skepticism is untenable, and can only be maintained by gross misrepresentation of the evidence. As a recent example, Boniol and colleagues conducted a modeling study in which they report that any beneficial effects of PSA testing on prostate cancer mortality are dramatically attenuated by deaths associated with prostate biopsy.

However, the estimate they use for biopsy mortality, 0.2 percent, is 400-fold higher than the estimate of the largest well-conducted study.

When we pointed this out to the authors, they dismissed our concern on the grounds that the study we cited lacked a control group, an unusual position for a study in which every death following … Continue reading 40-38 Guest Editorial

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