Volume 192 - Issue 2
Evidence-based uncertainty: recent trial results on prostate-specific antigen testing and prostate cancer mortality
Author: Peter C Arnold
Med J Aust 2010; 192 (2): 110. || doi: 10.5694/j.1326-5377.2010.tb03437.x
Published online: 18 January 2010
Published online: 18 January 2010
To the Editor: The general practitioners’ dilemma is acute. Women asking for mammography and/or testing for ovarian cancer; men asking for prostate-specific antigen (PSA) testing for prostate cancer. The debate, fuelled by uncertain knowledge, rages in the general medical journals,1,2 including contributions in the 17 August 2009 issue of the MJA.3,4
The PSA test is, of course, intimately associated with the name of its inventor, Thomas A Stamey. I am, therefore, somewhat surprised that neither of these recent MJA articles mentioned Stamey’s 2004 “recanting” of his proposed value of the test back in 1987: “current evidence from the last 10 years is convincing that the relationship between prostate cancer and serum PSA is tenuous at best, especially with serum PSA less than 10 ng/mL and perhaps even less than 22 ng/mL. This time is not the first we have had second thoughts regarding the usefulness of serum PSA in preoperatively reflecting prostate cancer”. He concludes: “any excuse to biopsy the prostate has an excellent, age dependent chance of being positive”.5
Perhaps the authors could tell your readers why they did not think that Stamey’s 20-year experience of PSA testing and his 2004 conclusions warranted a mention?
References
- Jørgensen KJ, Gøtzsche PC. Overdiagnosis in publicly organised mammography screening programmes: systematic review of incidence trends. BMJ 2009; 339: b2587. 0_CBBFGDHB
- Brown PO, Palmer C. The preclinical natural history of serous ovarian cancer: defining the target for early detection. PLoS Med 2009; 6: e1000114. doi: 10.1371/journal.pmed.1000114. 0_CBBEBCBI
- Smith DP, Banks E, Clements MS, et al. Evidence-based uncertainty: recent trial results on prostate-specific antigen testing and prostate cancer mortality [editorial]. Med J Aust 2009; 191: 199-200. 0_CBBHFGAE
- Barratt AL, Stockler MR. Screening for prostate cancer: explaining new trial results and their implications to patients [viewpoint]. Med J Aust 2009; 191: 226-229. 0_CBBJAHFA
- Stamey TA, Caldwell M, McNeal JE, et al. The prostate specific antigen era in the United States is over for prostate cancer: what happened in the last 20 years? J Urol 2004; 172: 1297-1301. 0_CBBEBGHI