Volume 199 - Issue 9
The dilemmas of prostate cancer screening
Authors: Nathan Lawrentschuk, Declan G Murphy and Anthony J Costello
Med J Aust 2013; 199 (9): 583. || doi: 10.5694/mja13.10779
Published online: 4 November 2013
Published online: 4 November 2013
To the Editor: We read with interest Del Mar and colleagues’
“re-examination” of the evidence for prostate cancer screening.1 Rather than presenting a balanced view, they have pursued a lopsided and flawed review of the data.
First, they have given equal weighting to the results of the screening trials from Europe (ERSPC [European Randomized Study of Screening for Prostate Cancer]) and North America (PLCO [Prostate, Lung, ...
To the Editor: We read with interest Del Mar and colleagues’ “re-examination” of the evidence for prostate cancer screening.1 Rather than presenting a balanced view, they have pursued a lopsided and flawed review of the data.
First, they have given equal weighting to the results of the screening trials from Europe (ERSPC [European Randomized Study of Screening for Prostate Cancer]) and North America (PLCO [Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial]), when clearly the contamination of the “non-screened” arm of the PLCO (about 50% of men in the non-screening arm were actually screened) is, by any statistical analysis, a failure of study design. The authors’ comment that “those on either side of the debate read the same information but interpret it differently, declaring that it supports their unchanged positions”,1 is disingenuous. What they should point out is that opposers of screening point to a flawed study (PLCO), and supporters of selective screening use a superior trial (ERSPC). As Hugosson and Carlsson’s article highlights, they also fail to include the latest update from the ERSPC.2
Second, Del Mar et al misrepresent the positive effect that prostate-specific antigen testing has had on prostate cancer mortality. Between 1991 and 2010, the age-standardised mortality rate for prostate cancer fell from 44/100 000 to 31/100 000, a 30% reduction.3
Australia has embraced surveillance,4 further minimising the impact of overdiagnosis, the very problem that even the ERSPC trial raises. But over time, the number of men needed to treat will continue to fall, resulting in harm reduction, and appropriately selected men will have radical treatment, saving lives. This perspective is missed by Del Mar et al.
Competing interests
No relevant disclosures.
References
- Del Mar CB, Glasziou PP, Hirst GH, et al. Should we screen for prostate cancer? A re-examination of the evidence. Med J Aust 2013; 198: 525-527. 0_BABHGFAJ
- Hugosson J, Carlsson SV. The dilemmas of prostate cancer screening. Med J Aust 2013; 198: 528-529. 0_pgfId-2895076
- Australian Institute of Health and Welfare, Australasian Association of Cancer Registries. Cancer in Australia 2012: an overview. Canberra: AIHW, 2012. (AIHW Cat. No. CAN 70; Cancer Series No. 74.) http://www.aihw.gov.au/publication-detail/?id=60129542359 (accessed Oct 2013).
- Evans SM, Millar JL, Davis ID, et al. Patterns of care for men diagnosed with prostate cancer in Victoria from 2008 to 2011. Med J Aust 2013; 198: 540-545. 0_i1142880