Volume 200 - Issue 10
Liaise with pathologists to refine understanding of the prostate-specific antigen test
Authors: Christopher B Del Mar, R Gordon Wright and Paul P Glasziou
Med J Aust 2014; 200 (10): 577-578. || doi: 10.5694/mja13.00130
Published online: 2 June 2014
Published online: 2 June 2014
Age-adjusted PSA medians may or may not predict prostate cancer screening outcomes
To the Editor: We are pleased to see Sikaris and colleagues agree with our concerns about the prostate-specific antigen (PSA) screening controversy, particularly overdiagnosis and inadequacies of the PSA test.1 However, we disagree with their conclusions about the value of PSA screening, which imply that the criticisms we raised2 can be neutralised if other PSA testing processes are used. The Royal College of Pathologists of Australasia (RCPA) position appears to be based on assuming that the European Randomized Study of Screening for Prostate Cancer3 is valid while the other major trials are flawed. However, this is cherry-picking, as there are no less serious potential methodological flaws in the European trial — with different clinical management of the controls and screened cancers which could account for better screened outcomes4 — than with the other trials.
We also disagree with Sikaris et al's proposal that pathologists offer information about the PSA tests with medians for age group to test-ordering doctors, coupled to the RCPA recommendations for a baseline PSA test at age 40 years.5 Age-adjusted PSA medians may, or may not, be predictive of prostate cancer screening outcomes. Before widescale adoption in clinical practice, this strategy first needs thorough evaluation by empirical testing — together with a number of other refinements of screening, such as new prostate cancer markers6 and magnetic resonance imaging.7
Competing interests
No relevant disclosures.
References
- Sikaris KA, Ross BA, Khong TY. Liaise with pathologists to refine understanding of the prostate-specific antigen test. Med J Aust 2013; 199: 656-658. 1
- 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. _ENREF_2
- Schröder FH, Hugosson J, Roobol MJ, et al; ERSPC Investigators. Prostate-cancer mortality at 11 years of follow-up. N Engl J Med 2012; 366: 981-990. _ENREF_3
- Haines IE, Gabor Miklos GL. Prostate-specific antigen screening trials and prostate cancer deaths: the androgen deprivation connection. J Natl Cancer Inst 2013; 105: 1534-1539. _ENREF_4
- Royal College of Pathologists of Australasia. Prostate specific antigen testing: age-related interpretation in early prostate cancer. http://www.rcpa.edu.au/search-result.aspx?searchtext=Prostate+Specific+Antigen+Testing%3a+Age-related+Interpretation&searchmode=allwords (accessed Feb 2014).
- Whitaker HC, Shiong LL, Kay JD, et al. N-acetyl-L-aspartyl-L-glutamate peptidase-like 2 is overexpressed in cancer and promotes a pro-migratory and pro-metastatic phenotype. Oncogene 2013; Nov 18 [Epub ahead of print]. doi: 10.1038/onc.2013.464. _ENREF_6
- Barentsz JO, Richenberg J, Clements R, et al. ESUR prostate MR guidelines 2012. Eur Radiol 2012; 22: 746-757. _ENREF_7