publication date: Apr. 14, 2017

Guest Editorial

How not to develop a medical intervention: Learning from the prostate screening debacle

By Otis Brawley, MD, MACP

Chief medical officer, American Cancer Society, Inc.



This week, the USPSTF issued its draft guidelines for prostate cancer screening. They propose shifting from task force’s recommendation against routine prostate cancer screening to a recommendation for informed and shared decision-making in which the physician and patient discuss the real risks of harm and the potential for life saving benefit before deciding on screening.

This guideline brings the TF in line with the guidelines of the American College of Physicians, the American Cancer Society, and the American Urological Association. It is useful to briefly review how we got here. This is a history of how not to develop a medical intervention. It is a story of ignorance and greed, and panic, and profiles in courage.

PCa is a leading cause of death. Metastatic prostate cancer causes tremendous pain and suffering. These are clear reasons demonstrating a need for an effective screening test and effective treatment. Perhaps the most important word in the last sentence is “effective.”

The serum prostate specific antigen test was developed in the late 1970’s and introduced in the mid 1980’s as a test to monitor disease. Several well-designed studies were conducted to show that it could be used to find early prostate cancer. Many jumped to the premise that early … Continue reading How not to develop a medical intervention: Learning from the prostate screening debacle

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