PSA screening shenanigans??


There was an editorial in the NY Times 11/26/14 written by the pathologist who discovered PSA in 1970 (and writer of a book on it, called "the great prostate hoax: how big medicine hijacked the psa test and caused a public health disaster" -- see http://www.nytimes.com/2014/11/26/opinion/the-problem-with-prostate-screening.html?ref=opinion&_r=0​ .  there was also a recent interview of him by Eric Topol -- see http://www.medscape.com/viewarticle/828854_1​ . his basic comments:

--in reviewing the European Randomized Study of Screening for Prostate Cancer (ERSPC), and the Swedish Goteberg study (which was the basis for the European one) and had a 44% reduction in prostate cancer deaths, they refused to allow outside investigators to review the data. (the 11-year followup reported in NEJM from the whole  ERSPC was 29% reduction in those adherent to the study-- see N Engl J Med 2012; 366:981-990)
--there were inherent concerns about about the methadology, including transferring 60% of the data from Goteberg to the ERSPC, strongly tipping the balance of the 7-country study by this one country which showed such a dramatic positive result.
--there were significant conflicts of interest in the investigators, being involved in companies that market PSA tests or related technologies.

so, just muddies the water a bit more (and who would have thought they could be muddier). the US study, also reported in NEJM (see N Engl J Med 2009; 360:1310-1319), did not find benefit from screening, though had its own issues (much contamination of the groups). Ablin might also have his own issues: he discovered the PSA test, targeted it for use as a marker to follow known prostate cancer and not a screening test, may be promoting his book, etc. but it is certainly concerning if the most positive study (ERSPC) is potentially biased by a single Swedish study, and they will not release their data for review.....

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