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4 Comments

  1. 1
    Melissa Sweet

    Melissa Sweet

    Professor Chris Baggoley, Chief Executive, Australian Commission on Safety and Quality in Healthcare, sent in this comment: I remain confused about the benefits, or otherwise, for PSA testing and I am very much in the age group that needs to the simple answer you hope for in your piece. I’m not so sure that Norman Swan isn’t selling men short if he does believe that they can only focus on one thing at a time. We can cope with prevention of hypertension and heart disease at the same time as focussing on prostates. I think we can think about our prostates while running!

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  2. 2
    Melissa Sweet

    Melissa Sweet

    Just to be fair to Norman; he was not making the comment about men being overly distracted by their prostates. It was his interviewee, the author of the NEJM editorial, Dr Michael Barry from Harvard Medical School. His editorial is freely available at: http://content.nejm.org/cgi/content/full/360/13/1351

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  3. 3

    Clive Deverall

    So..the confusion continues but the end point of both the recent sstudies appears to be that so-called screening finds more prostate cancers yet in finding those cancers early does little to reduce the risk of dying from the disease. But amongst the numerous comments following publication is the very surprising one from Dr Otis Brawley, the Chief Medical Officer of the American Cancer Society who said – of the data in the European study (in the New York Times): “The test is about 50 times more likely to ruin your life than it is to save your life”. Now, lets not forget that the American Cancer Society has over the years stubbornly supported PSA screening. They have been the only cancer society in the NGO sector in the western world to support the test. Does this mean they have re-considered? Or is Dr Brawley having a problem persuading his professional colleagues that the time has come to think again?

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  4. 4

    Gavin Mooney

    On PSA tests, having set this particular ball rolling and having read the many comments on Crikey/Croakey, I first want to thank all those who have contributed. What an amazingly broad set of comments they are! That breadth in itself is interesting – and useful.

    Let me pick however on a couple of comments from Sally Crossing of Cancer Voices:

    “The big question for us is – how can the individual or his doctor, know if he falls into the “harm” category – over-diagnosis and possible over-treatment, or not?” Seemingly no ‘big question’ about anxiety or about resource use?

    “We also suggest that few individual men will want to wait for their prostate cancer to develop more compelling symptoms, with consequent less chance of effective treatment and recovery.” Maybe but how many ‘individual men’ sit around waiting and wondering if their cancer will develop? And if the PSA test did not exist how many fewer men would sit around waiting and wondering?

    “What is of most interest to prostate cancer patients is years of survival and quality of life….?” Is it? Is this statement evidence based? For me yes both years of survival and quality of life matter but I note that here and in many other comments the question of anxiety gets missed or down played.

    Sally goes on: “Cancer Voices must look at this from the cancer consumer view point- and particularly of the prostate cancer consumer – rather than that of researchers, epidemiologists, clinicians or health economists.” Yes that seems reasonable but then if I had never had a PSA test I wouldn’t have joined the ranks of the ‘prostate cancer consumers’. (In passing, PLEASE can we have some other terminology than ‘prostate cancer consumers’! This is not a market place with ‘consumers ‘ – or is it?)

    My main beef originally was that I (and I suspected other men) were simply not being given the information necessary to make an informed rational decision. There are now fewer excuses for that to continue.

    Can someone somewhere keep an eye on the number of PSA tests conducted before and after the publication of the results of these two studies? They must surely go down … surely!

    On fee-for-service (FFS) medicine which I indicated worries me in this context and in others (how many PSA tests if there were no fee?), there is evidence that fee-for-service medicine leads to more activity. But Jon Hunt writes: “The problem with not using FFS is that it doesn’t matter how much work you do you get paid the same, so perhaps I should call in for a Monday sickie once in a while like everybody else.” Where has the professionalism of medicine gone – or is such professionalism just a silly old fashioned idea and is medicine now just another commodity like potato chips or another service like hair cuts?

    And to finish: writing this in AIDS ravaged and poverty ravaged and inequality ravaged South Africa, the waste of resources (as Melissa Sweet acknowledges) on many unnecessary PSA tests is not just stunning but disturbingly unethical.

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