Volume 193 - Issue 7
Has PSA testing truly been a "public health disaster"?
Authors: Anthony J Costello and Declan Murphy
Med J Aust 2010; 193 (7): 431. || doi: 10.5694/j.1326-5377.2010.tb03989.x
Published online: 4 October 2010
Published online: 4 October 2010
In reply: Chapman and Barratt’s statements about prostate cancer highlight the dramatic difference between the views of sociologists and the views of clinicians who deal daily with the burden of prostate cancer diagnosis, treatment and mortality. In 1851, prostate cancer was considered a rare disease.1 Chapman and Barratt’s views seem to remain consistent with this thesis. However, in 2010 in Australia, prostate cancer is the most common cancer diagnosed in men, and the most common cancer causing death in men.
Our own data do not support the contention that treatment for prostate cancer produces dreadful outcomes. We can reassure men that there is a high likelihood of cure through early treatment for prostate cancer, with a less than 5% chance of becoming incontinent and a 70% chance of retaining erectile function.2
Clearly, Chapman and Barratt have not taken into account a recently reported Swedish study which showed that in 20 000 men randomly allocated to prostate-specific antigen (PSA) screening or a control group between 1994 and 2008, there was a 50% reduction in mortality from prostate cancer for men in the screened arm.3 The numbers needed to screen (293) and treat (12) from this study are almost exactly the same as those from breast cancer screening studies.
We repeat our recommendation for the early use of a single PSA test4 in men aged in their 40s. This is most beneficial because the background noise from benign prostatic hyperplasia development does not occur, and PSA level is very discriminatory for detecting those who go on to develop significant prostate cancer.
References
- Adams J. The anatomy and diseases of the prostate gland. London: Longman, Brown, Green and Longmans, 1851. 0_CBBIIGJF
- Murphy DG, Kerger M, Crowe H, et al. Operative details and oncological and functional outcome of robotic-assisted laparoscopic radical prostatectomy: 400 cases with a minimum of 12 months follow-up. Eur Urol 2009; 55: 1358-1367. 0_i1095403
- Hugosson J, Carlsson S, Aus G, et al. Mortality results from the Göteborg randomized population-based prostate-cancer screening trial. Lancet Oncology 2010; 11: 725-732. doi: 10.1016/S1470-2045(10)70146-7. 0_CBBGDDCH
- Challacombe BJ, Murphy D, Lilja H, et al. The continuing role of prostate specific antigen as a marker for localised prostate cancer: “Do not throw the baby out with the bath water”. BJU Int 2009; 104: 1553-1554. 0_i1095409