A clinical review in this week’s issue of the British Medical Journal (BMJ) states clearly that “Prostate cancer screening with the PSA blood test results in at most a small reduction in prostate cancer mortality and leads to considerable diagnostic and treatment related harms” and that “Physicians should recommend against PSA screening for prostate cancer.” This article by Wilt and Ahmed is a revised and updated version of a prior clinical review that also appeared in the BMJ.
American readers of this blog won’t be surprised by Dr. Wilt’s stance on this issue. Dr. Wilt was the lead investigator in the design and conduct of the PIVOT study that compared radical prostatectomy to expectant management in men with localized disease. He has also been a member of the of the U.S. Preventive Services Task Force. On the other hand, some readers may be surprised by Dr. Ahmed’s co-authorship of this paper since Dr. Ahmed is a urologist and a leading specialist in the treatment of prostate cancer in the UK. He has, for example, been heavily involved in the exploration of high-intensity focused ultrasound (HIFU) as a treatment for localized prostate cancer and the use of HIFU and other techniques in focal therapy.
As usual, The “New” Prostate Cancer InfoLink wishes to draw a very clear line in the sand to distinguish between “screening” (the mass, annual, population-based use of the PSA test) and “testing” of individuals based on actual risk (age, race, family history, and other factors) and possible, early, clinical indications of in individual patients (e.g., lower urinary tract symptoms or LUTS). We believe that the PSA test is a clinically useful test when used appropriately but that its current use is very definitely associated with (but not necessarily causative of) over-treatment — and arguably over-diagnosis — of clinically insignificant forms of prostate cancer.